Hepatobillary Disease

Question 1

Viral Hepatitis

Answer 1

Common symptoms: N + V, Anorexia, myalgia, lethargy + RUQ pain.

Consider Foreign Travels / IV drug use

Question 2

Congestive Hepatomegaly

Answer 2

If liver is stretched = Pain.

Can occur due to congestive HF. Severe cases cirrhosis can occur.

Question 3

Biliary colic

Answer 3

RUQ pain (intermittent) lasts couple of minutes then gradually goes away. Pain occurs during eating. Can become Nauseous.

RF: FFFFF

Question 4

Acute Cholecystitis

Answer 4

Pain similar to biliary colic but severe (very persistent). Pain radiates to the back / right shoulder.

May be pyrexial + Murphy’s sign +ve.

Question 5

Ascending Cholangitis

Answer 5

infection of the bile ducts. 2ndry to gallstones. Symptoms charcots triad: Fever, jaundice, RUQ pain

Question 6

Gallstone ileus

Answer 6

Small bowel obstruction. 2ndry to impacted gallstones. Developing of fistulas forms between a gangrenous gallbladder + duodenum.

Symptoms: Abdo pain, distension + V

Question 7

Cholangiocarcinoma

Answer 7

Symptoms similar to biliary colic but persistent; anorexia, jaundice and weight loss.

A palpable mass in the RUQ (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) + left supraclavicular adenopathy (Virchow node)

Question 8

Acute pancreatitis

Answer 8

Due to alcohol + gallstones. Severe epigastric pain + Vomiting is common.
Examination may reveal tenderness, ileus and low-grade fever.
Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare.

Question 9

Pancreatic cancer

Answer 9

Painless jaundice (classic).
Can have pain, anorexia + wt loss

Question 10

Amoebic liver disease

Answer 10

Malaise, anorexia + wt loss.

RUQ pain tends to be mild + jaundice is uncommon.