The clinical feature and lab tests of the liver, biliary and pancreas diseases

1. The clinical feature and lab tests of the liver, biliary and pancreas diseases

2.

3.

4. Pain

Localization:
- liver disease - right hypochondrium
-
diseases of the BT- right hypochondrium,
epigastrium
-
diseases of the pancreas - the upper part of
the anterior abdominal wall

5. Pain

The nature and intensity of pain - any, but
biliary colic is more typical for BT pathology
Irradiation is varied, but irradiation to the right
and left with the transition to the back is
pathognomonic for pancreatitis
Duration - different

6. Pain

Provocation:
- The relationship with food intake is usually
determined by the nature of the food (fatty,
smoked ...), and not by the fact of eating!
-In hepatitis and pancreatitis may be association
with alcohol use!
Cupping is not specific, but antispasmodics
often help with BT diseases

7. Pain eponymous symptoms

BT diseases
Murphy s.
Eisenberg s.
Mussi s.
point Bergman
point Boas
Punch tenderness in right upper quadrant

8.

Pancreas diseases:
Kerte s.– pain in pancreas proection
Kach s. – hypersensitivity
p. Desjardins
∆ Shoffard
p. Mayo-Robson
Painful but not eponymous turning symptom
Eponymous but not painful symptoms: Grotte
(Cupid's bow), Gray-Turner, Cullen

9.

Conclusion: detailing the pain can
help in the diagnosis, but the
diagnostic significance may be.
insufficient for a confident diagnosis
Low specificity of the majority of
symptoms !
specificity – absence in absence

10. Additional syndroms

Gastric dyspepsia – nonspecific
Biliary dyspepsia - reflects duodenal
dyskinesia, not specific
Small bowel diarrhea and malabsorption more often the result of exocrine pancreatic
insufficiency, but may be with severe bile acid
deficiency

11.

Insulin deficiency is a sure sign of β-cell damage
Inflammatory Syndrome – Nonspecific
Jaundice and cholestasis are common symptoms
for liver, biliary, and pancreas pathology
Hepatomegaly is a good helper
Splenomegaly - a late symptom
Hypersplenism - laboratory syndrome

12.

Hepatocellular failure syndrome significantly increases the likelihood of liver
pathology, especially the presence of signs of
hepatic encephalopathy
HE – drowsiness
- impaired attention and memory,
- flapping tremor- asterixis
- confusion
- stupor
- coma

13. Hepatocellular failure syndrome

Teleangiectasia
Jaundice
Edema
muscular atrophy
hemorrhages (1972)
vitamin K dependent clotting factors – 2-7-9-10

14.

-
-
-
Portal Hypertension Syndrome is an accurate
but late sign of probable liver disease
The reason is a violation of the
angioarchitectonics of the liver
Symptoms: ascites, distension of portocaval
anastomoses on the anterior abdominal wall
(Medusa's head),
in the esophagus (esophageal varices),
in rectum (hemorrhoids)

15.

16.

17.

18.

19. Lab test syndromes

-
For L-B-P pathology
- hyperbilirubinemia (conjugated,
unconjugated, mixed)
Inflammatory syndrome
anemic
cholestasis (ALP, GGTP)

20. Lab test syndromes

-
-
-
With liver diseases:
HCFS (total protein, albumin, cholesterol,
INR)
Cytolysis (increase in AST, ALT), but may be
secondary (due to cholestasis or general
inflammatory reaction)
Hypersplenism (anemia, leukopenia,
thrombocytopenia)

21.

-
For diseases of the pancreas:
inflammatory-necrotic (amylase, lipase, trypsin
in the blood)
-
exocrine insufficiency = Malabsorption
-
insuline insufficiency (hyperglycemia, low cpeptide levels)

22. Ultrasound of the abdominal cavity

Liver pathology
- exclusion of focal pathology, detection of
ascites, hepato-splenomegaly, portal
hypertension
Bile tract deseases
- Stones and deformation of the gallbladder
Pancreatic pathology
-dimensions
-calcification, tumors, cysts, inflammatory
edema

23. Endoscopy

Esophagus varices
Duodenopapilloscopy

24. X-ray

CT
MRI
PET

25. N liver

26. Echinococcosis cyst

27.

ascites
uneven surface
High density

28.

29. CT

30.

31. MRI cholangiography