Liver Disease Signs and Symptoms

Question 1

Presentation of liver disease

Answer 1

1. Pain: right hypochondrium or epigastric, constant. *Cholelithiasis *pain is intermittent and related to fatty meals.
2. Jaundice
3. Skin discolouration: haemachromatosis
4. Bruising
5. Pruritis (cholestatic liver disease)
6. Lethargy
7. Nausea and vomiting: acute hepatobiliary disease and alcoholism
8. **Loss of appetite and weight: **cirrhosis, malignancy
9. Fever: infection, inflammation and cirrhosis

Question 2

Drugs that cause acute hepatitis

Answer 2

halothane, phenytoin, ketaconazole (antifungal)

Question 3

Drugs that cause acute liver necrosis

Answer 3

paracetamol overdose

Question 4

Drugs that cause cholestasis

Answer 4

rifampicin, oral contraceptive pill, anabolic steroids

Question 5

What is important past medical history for liver disease?

Answer 5

1. Anaesthesia: jaundice (drugs)
2. Cholecystectomy
3. Surgery: damage to bile ducts with upper abdominal surgery
4. Metabolic syndrome, insulin resistance: fatty liver

Question 6

Relevant family history liver disease

Answer 6

1. Especially for hyperbilirubinaemia (jaundice)
2. Haemolytic anaemias – hereditary spherocytsis, thalassaemia
3. Congenital Hyperbilirubinaemia – Gilbert’s syndrome
4. Autoimmune disease – haemolysis, autoimmune hepatitis

Question 7

General inspection signs of liver disease

Answer 7

1. Jaundice
2. Weight and wasting
3. Pigmentation
4. Mental state
5. Telangiectasia

Question 8

Grading of mental state

Answer 8

Grade 0 - normal mental state

Grade 1 - mental changes (lack of awareness, anxiety, euphoria, reduced attention span, impaired ability to add and subtract)

Grade 2 - lethargy, disorientation (for time), personality changes, inappropriate behaviour

Grade 3 - stupor, but responsive to stimuli; gross disorientation, confusion

Grade 4 - coma

Question 9

Hepatic encephalopathy

Answer 9

Indicates serious deterioration. Thought to be due to increased ammonia and other toxins entering the peripheral and cerebral circulation. Due to poor liver cell function or portosystemic shunting in portal hypertension

Occurs in:

1. acute liver failure
2. chronic cirrhosis - often sudden onset precipitated by infection, GIT bleed, hypoglycaemia, alcohol binge or medication

Question 10

Spider naevi

Answer 10

seen in cirrhosis esp alcoholic, ? oestrogen

Question 11

Asterixis

Answer 11

Thought to be a disorder of the nervous system occurring at level of brain – sign of liver failure

Question 12

How do you describe a liver border?

Answer 12

1. Tender?
2. Firm or soft?
3. Regular or irregular?
4. Pulsatile?

Question 13

Causes of a firm and irregular liver

Answer 13

1. Hepatocellular carcinoma
2. Metastatic disease
3. Cirrhosis
4. Hydatid disease,
5. Granuloma (eg sarcoid)
6. Amyloid
7. Cysts,
8. Fatty liver

Question 14

Causes of a tender liver

Answer 14

1. Hepatitis
2. Rapid liver enlargement eg right heart failure, Budd-Chiari syndrome (hepatic vein thrombosis)
3. Hepatocellular cancer
4. Hepatic abscess
5. Biliary obstruction/cholangitis

Question 15

Causes of a pulsatile liver

Answer 15

1. Tricuspid regurgitation
2. Hepatocellular cancer
3. Vascular abnormalities

Question 16

Cause of a large spleen

Answer 16

Enlarged in portal hypertension

Question 17

Cause of peripheral oedema in liver disease

Answer 17

low albumin

Question 18

Temperature in liver disease

Answer 18

Raised in acute hepatitis, acute cholecystitis, peritonitis

Question 19

What signs suggest liver cirrhosis?

Answer 19

The presence of two or more of the following signs suggests cirrhosis:

1. spider naevi
2. palmar erythema
3. splenomegaly or ascites
4. abnormal collateral veins on the abdomen
5. ascites