Hepatobiliary disease classical exam q features (Passmed)

Question 1

Viral hepatitis

Answer 1

Common symptoms:

• Nausea & vomiting, anorexia
• Myalgia
• Lethargy
• RUQ pain

Questions may point to risk factors e.g. foreign travel, IV drug use

Question 2

Congestive hepatomegaly

Answer 2

The liver only usually causes pain if stretched - e.g. as a consequence of congestive heart failure. In severe cases, cirrhosis may occur

Question 3

Biliary colic

Answer 3

RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating.
Nausea is common
Female, forties, fat, fair

Question 4

Acute cholecystitis

Answer 4

Pain similar to biliary colic but more severe & persistent.
Pain may radiate to back or right shoulder
May be pyrexial and Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

Question 5

Ascending cholangitis

Answer 5

Infection of the bile ducts commonly secondary to gallstones. 
Classically presents with a triad of: 
- fever (rigors are common) 
- RUQ pain 
- jaundice

Question 6

Galstone ileus

Answer 6

= small bowel obstruction secondary to an impacted gallstone
May develop if a fistula forms between a gangrenous gallbladder and the duodenum
Abdo pain, distension & vomiting are seen

Question 7

Cholnagocarcinoma

Answer 7

Persistent biliary colic symptoms, associated with anorexia, jaundice, weight loss
Courvoisier sign = a palpable mass in teh right upper quadrant
Sister Mary Joseph nodes = periumbilical lymphadenopathy
Virchow node = supraclavicular adenopathy

Question 8

Acute pancreatitis

Answer 8

Usually due to alcohol or gallstones
Severe epigastric pain
Vomiting is common
Exam may reveal tenderness, ileus, low grade fever
Cullens’s sign = periumbilical discolouration
Grey-Turner’s sign = flank discolouration

Question 9

Pancreatic cancer

Answer 9

Classical presentation: painless jaundice
Pain is actually a relatively common presenting feature
Anorexia & weight loss are common

Question 10

Amoebic liver abscess

Answer 10

Typical symptoms: malaise, anorexia, weight loss
Associated RUQ pain tends to be mild
Jaundice is uncommon

Question 11

IBS

Answer 11

Consider if reports (for >6month duration):

• abdo pain and/or
• bloating and/or
• change in bowel habit

Positive diagnosis should be made if have abdo pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of: altered stool passage, abdo bloating/distension, tension/hardness, symptoms worse on eating, passage of mucus

Question 12

Colorectal cancer red flags

Answer 12

Rectal bleeding
Unexplained/unintentional weight loss
FHx of ovarian or bowel cancer
Onset after 60

Question 13

Primary biliary cirrhosis

Answer 13

Itching in a middle aged woman
Raised ALP and gamma GT

CHECK

Question 14

Autoimmune hepatitis

Answer 14

Most commonly seen in young females
Recognised associations: other autoimmune disorders, hypergammaglobulinaemia, HLAB8 DR3
May present with signs of chronic liver disease
~25% prevent with acute hepatitis
Amenorrhea is common.