Signs and Symptoms Flashcards
What does conjugated hyperbilirubinaemia cause?
- Dark urine
- Pale stools (no bilirubin in small intestine)
- Itch
What causes jaundice?
High levels of bilirubin in the body - plasma bilirubin >50uM/L.
- Unconjugated i.e. not from liver or biliary tree
- Conjugated i.e. liver and biliary disorders
What is obstructive jaundice?
Blockage of flow of bile through the bile ducts or intrahepatic or extrahepatic ducts
What is hepatocellular jaundice?
Hepatocyte damage e.g. hepatitis, cirrhosis
Causes of obstructive jaundice
- Gallstones - biliary colic, cholecystitis/cholangitis
- Carcinoma of head of pancreas
- Sclerosing cholangitis - scarring of small bile ducts in liver leading to obstruction
- Cholangiocarcinoma
- LN mets
- Chronic pancreatitis
Causes of hepatocellular jaundice
- Alcoholic hepatitis or cirrhosis
- Viral hepatitis
- Drug-induced e.g. paracetamol overdose
- Non-alcoholic fatty liver disease
- Autoimmune liver disease
- Haemochromatosis
- Wilson’s disease
How does biliary colic present?
Right upper quadrant pain due to gallstone in cystic duct. If associated with jaundice and fever - indicates cholangitis e.g. sepsis in biliary ducts.
Pain lasts from 1 to a few hours.
How does pancreatitis present?
Severe epigastric pain radiating to back. Usually caused by alcohol excess or gallstone blocking of common bile duct.
What does painless jaundice indicate?
Liver or pancreatic cancer
Risk factors for jandice
- Alcohol intake
- Drug use including non-prescription drugs
- Travel
- Blood transfusions
- Tattoos
- Unprotected sexual activity
How does acute hepatitis present?
- Unwell
- Jaundice
- RUQ pain (liver swells but is held in capsule which is stretched and causes pain)
- Confusion
- Coagulopathy
How does chronic hepatitis present?
- Low grade inflammation >6 months
- Often asymptomatic
- Fatigue
- Vague RUQ pain
Stigmata of cirrhosis
- Palmar erythema - increased oestrogen levels or nitric oxide
- Leuconychia - pale nails due to decreased albumin or general hepatitis cirrhosis
- Spider naevi - increased oestrogen levels dilates blood vessels
- Caput medusa - enlarged superficial periumbilical veins due to portal hypertension
Symptoms of alcoholic hepatitis
- Jaundice
- Large tender liver
- Vomiting
- Stops drinking alcohol
- Alcohol withdrawal
- Liver failure and risk of death
Cirrhosis timeline
- Asymptomatic at first due liver compensation
- Then jaundice, ascites, encephalopathy, variceal bleeding
- Varicose veins - rectum, abdomen
What drugs can cirrhosis cause extreme sensitivity to?
Sedatives e.g. Benzodiazepenes, opiates
Signs of hepatic encephalopathy
- Asterixis
- Confusion/disorientation
- Decreased consciousness
- Slurred speech
Signs of chronic liver disease
- Palmar erythema
- Spider naevi
- Parotid enlargement
- Gynecomastia
- Muscle atrophy
- Asterixis
- Dupuytren’s contracture
- Troisier’s node - enlargement of left supraclavicular node)
What are the signs and symptoms of a pathogenic pancreas?
- Diarrhoea
- Bloating
- Flatulence
- Oily and foul-smelling stool
- Weight loss
- Malnutrition
- Poor blood sugar control
- Diabetes
Symptoms of acute pancreatitis?
- Intense pain in upper abdomen that radiates to back
- Nausea/vomiting
- Fever
Symptoms of chronic pancreatitis?
- abdominal pain - intermittent or chronic and is frequently severe
- intense stabbing in epigastric region
- may radiate to back
- sometimes triggered by high fat foods
- oily, foul-smelling stool
- weight loss
What are the symptoms of cholecystitis?
- Mid epigastric pain that’s continuous
- As gallbladder expands pain can spread to RUQ
- Dull, achy pain which can radiate to right scapula and shoulders
What are the long term consequences of cholecystitis?
- Sepsis
- Jaundice
- Increased ALP
Symptoms of heptocellular liver disease
- Dull RUQ pain
- No steatorrhea
- ALT markedly elevated
- ALP mildly elevated
- Albumin decreased
- Increased INR - not correctable
- US - liver enlarged/shrunken +/- splenomegaly
