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20 Cards in this Set
- Front
- Back
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True/False. The symptoms of acute hepatitis and biliary obstruction can be quite similar with lots of overlap between them.
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True
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Is pain associated with biliary obstruction?
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Yes, it can be.
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Is pain associated with acute hepatitis?
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Yes, there can be, but it can also be asymptomatic
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Where would one expect to find the pain in someone with biliary obstruction?
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Right upper quadrant or epigastrium
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If pain were to present with acute hepatitis, where would you expect to see it?
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Right upper quadrant
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Where does referred pain from the liver or biliary tract occur?
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The back and right scapular and shoulder
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A patient presents with a sudden onset, severe, constant pain that lasted about an hour. Would this be more indicative of Acute Hepatitis or Biliary Obstruction?
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Biliary Obstruction – the pain can be very severe lasting from 30 minutes to 5 hours with stones...longer would imply acute cholecystitis (Harrison).
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Is there always pain associated with biliary obstruction?
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No. If gradual obstruction of the CBD (common bile duct) over weeks or months (by narrowing), often no pain is associated with jaundice.
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What is the difference between a sign and a symptom?
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Sign = something that is observed
Symptom = something the patient reports to you |
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What are some common “symptoms” that could be associated with both acute hepatitis AND biliary obstruction?
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abdominal pain/discomfort, nausea, chills, and general malaise (note: in some cases they could also be asymptomatic)
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What are some common signs of biliary obstruction?
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Jaundice, fever, RUQ pain
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What clinical presentation generally precedes the onset of jaundice in acute viral hepatitis?
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“flu-like” symptoms of malaise, fatigue, anorexia, nausea, vomiting, myalgia, and headache. These generally occur 1-2 weeks before the onset of jaundice.
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What “signs” might be found on examination of a patient with acute hepatitis?
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There may be jaundice, low-grade fever, tender and enlarged liver, possible splenomegaly. (note: can be asymptomatic)
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A patient presents to the office with jaundice and a constant, mild abdominal discomfort in the upper right quadrant. Is this more indicative of Acute Hepatitis or Biliary Obstruction?
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Acute Hepatitis would be higher on the differential due to mild nature of pain, but it could still be biliary obstruction so further testing required. Note: there is not always pain associated with acute hepatitis.
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What are some causes of acute hepatitis?
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Viral infection, alcohol, toxins, drugs, autoimmune
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What is the main symptom that can be used to help differentiate between acute hepatitis and biliary obstruction?
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The type and nature of pain described by the patient.
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List some causes of biliary obstruction.
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Common duct stones (choledocholithiasis), acute cholangitis (primary sclerosing cholangitis), biliary strictures, infection, biliary neoplasms.
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The classic signs/symptoms of biliary obstruction are termed “charcot’s triad”. What 3 sign’s/symptoms does this include?
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abdominal pain, jaundice, and fever
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How could one definitively differentiate between acute hepatitis and biliary obstruction?
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ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatopgraphy)
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If low grade fever occurs with a patient suspected to have acute viral hepatitis, which strains would be suspected? (A,B,C,D,E)
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Hepatitis A or E. Rarely Hep B is associated with fever
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