Hepatobiliary disease and related disorders
The table below gives characteristic exam question features for conditions causing hepatobiliary disease and related disorders:
| Condition | Features |
|---|---|
| Viral hepatitis | Common symptoms include:
Questions may point to risk factors such as foreign travel or intravenous drug use. |
| Congestive hepatomegaly | The liver only usually causes pain if stretched. One common way this can occur is as a consequence of congestive heart failure. In severe cases cirrhosis may occur. |
| Biliary colic | RUQ pain, intermittent, usually begins abruptly and subsides gradually. Attacks often occur after eating. Nausea is common. It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation. |
| Acute cholecystitis | Pain similar to biliary colic but more severe and persistent. The pain may radiate to the back or right shoulder. The patient may be pyrexial and Murphy's sign positive (arrest of inspiration on palpation of the RUQ) |
| Ascending cholangitis | An infection of the bile ducts commonly secondary to gallstones. Classically presents with a triad of:
|
| Gallstone ileus | This describes small bowel obstruction secondary to an impacted gallstone. It may develop if a fistula forms between a gangrenous gallbladder and the duodenum. Abdominal pain, distension and vomiting are seen. |
| Cholangiocarcinoma | Persistent biliary colic symptoms, associated with anorexia, jaundice and weight loss. A palpable mass in the right upper quadrant (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen |
| Acute pancreatitis | Usually due to alcohol or 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 |
| Pancreatic cancer | Painless jaundice is the classical presentation of pancreatic cancer. However pain is actually a relatively common presenting symptom of pancreatic cancer. Anorexia and weight loss are common |
| Amoebic liver abscess | Typical symptoms are malaise, anorexia and weight loss. The associated RUQ pain tends to be mild and jaundice is uncommon. |