Hepatobiliary disease in afya

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Common Sx
N&V, anorexia, myalgia, lethargy, RUQ pain

''Viral Hepatitis''
symptoms - n&v, anorexia, myalgia, lethargy, RUQ pain
risk factors - foreign travel or IV drug use.

''Congestive hepatomegaly''
liver only causes pain if stretched. eg  as a consequence of congestive heart failure.
If severe cirrhosis may occur.

''Biliary colic''	
RUQ pain, intermittent (begins abruptly and subsides gradually) 
Attacks often occur after eating. Nausea is common.
patients are female, forties, fat and fair

''Acute cholecystitis''
Pain similar to biliary colic but more severe and persistent - may radiate to back or right shoulder.
pyrexial and Murphy's sign positive (arrest of inspiration on palpation of the RUQ)

''Ascending cholangitis''
infection of bile ducts secondary to gallstones. 
triad - fever (rigors), RUQ pain, jaundice

''Gallstone ileus''
small bowel obstruction secondary to an impacted gallstone.
may develop if a fistula forms between a gangrenous gallbladder and the duodenum.
Abdominal pain, distension and vomiting

''Cholangiocarcinoma''
Persistent biliary colic symptoms, with anorexia, jaundice and weight loss. 
palpable mass in RUQ (Courvoisier sign), periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node)

''Acute pancreatitis''
due to alcohol or gallstones
Severe epigastric pain, Vomiting
tenderness, ileus and low-grade fever
Periumbilical discolouration (Cullen's sign) and flank discolouration (Grey-Turner's sign) - rare

''Pancreatic cancer''
Painless jaundice  classically (though pain is common) Anorexia and weight loss

''Amoebic liver abscess''
malaise, anorexia and weight loss, mild RUQ pain (jaundice is uncommon).

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