Liver and friends Flashcards
N+V anorexia myalgia lethargy RUQ pain Questions may point to risk factors such as foreign travel or intravenous drug use.
Viral hepatitis
The liver only usually causes pain if stretched. In severe cases cirrhosis may occur. One common way this can occur is as a consequence of …?
Congestive hepatomegaly One common way this can occur is as a consequence of congestive heart failure.
RUQ pain, intermittent, begins abruptly –> subsides gradually. Attacks AFTER eating. Nausea is common. Female, Forties, Fat and Fair although this is obviously a generalisation.
Biliary colic
Pain similar to biliary colic i.e. (RUQ pain, fever intermittent, begins abruptly –> subsides gradually. Attacks AFTER eating. Nausea is common.) BUT more severe and persistent. The pain may radiate to the back or right shoulder.
Acute cholecystitis
Charcot Triad of: fever (rigors are common) RUQ pain jaundice
Ascending cholangitis - infection of the bile ducts commonly secondary to gallstones
Bowel obstruction secondary to an impacted gallstone. Hx of RUQ pain colicky X-ray = multiple dilated loops, air in biliary tree!!! Abdominal pain, distension and vomiting are seen.
Gallstone ileus It may develop if a fistula forms between a gangrenous gallbladder and the duodenum.
Persistent biliary colic symptoms (i.e. RUQ pain, intermittent, begins abruptly –> subsides gradually. Attacks AFTER eating. Nausea is common.) assoc with anorexia, jaundice and WL. A palpable mass in the right upper quadrant (What sign?) periumbilical lymphadenopathy (Which node?) left supraclavicular adenopathy (Which node?) may be seen High bili, HIGH ALP
Cholangiocarcinoma A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) left supraclavicular adenopathy (Virchow node) may be seen Flukes clonorchis, primary sclerosing, nitrosamines
Usually due to alcohol or gallstones Severe epigastric pain Vomiting is common Examination may reveal tenderness, ileus and low-grade fever Periumbilical discolouration (Which sign?) and flank discolouration (Which sign?)
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign)
Painless jaundice #classic Anorexia and weight loss are common
Pancreatic cancer
Malaise, anorexia and weight loss, mild RUQ pain RIGHT lobe mass Fluid filled Poor defined boundaries Anchovy paste @ aspiration
Amoebic liver abscess
history of NSAID use or alcohol excess. Which ulcers: more common? Epigastric pain BETTER by eating Epigastric pain WORSE by eating Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc)
Duodenal ulcers: more common than gastric ulcers, epigastric pain relieved by eating = duod epigastric pain worsened by eating = gastric
Pain initial in the central abdomen before localising to the right iliac fossa (RIF). Anorexia, Tachycardia, low-grade pyrexia, tenderness in RIF Which sign: more pain in RIF than LIF when palpating LIF?
Appendicitis Rovsing
Colicky pain typically in the LLQ Diarrhoea, sometimes bloody. Fever, raised inflammatory markers and white cells sudden onset profuse dark red rectal bleeding. She was previously well.
Acute diverticulitis
History of malignancy (intraluminal obstruction)/previous operations (adhesions) Vomiting. Not opened bowels recently CENTRAL pain constipation sounds TINKLING!!!! tumour tender absent of flatus n+v distended Ix??
Bowel obstuction 1. AXR 2. CT CONFIRM!!!
Loin pain radiating to the groin severe but intermittent. Patient’s are characteristically restless. Visible or non-visible haematuria may be present
Renal colic
Loin pain + Fever and rigors are common as is vomiting
Acute pyelonephritis
Suprapubic pain common in men, who often have a history of benign prostatic hyperplasia
Urine retention
RIF/LIF pain and a history of amenorrhoea for the past 6-9 weeks. Vaginal bleeding may be present
Ectopic
Central abdominal pain radiating to the back: catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock) Patients may be shocked (hypotension, tachycardic) Patients may have a history of cardiovascular disease
Rupt AAA
Central abdominal pain History of atrial fibrillation or other cardiovascular disease Diarrhoea, rectal bleeding may be seen A metabolic acidosis is often seen (due to ‘dying’ tissue)
Mesenteric ischaemia
Projectile, non-bilious vomiting, olive mass @ RUQ, HYPO-nat/kal/chlor ALKalosis
Pyloric stenosis USS/test feed PyloroMyoTomy
