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

Август 23, 2022

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

Содержание

4. Pain Localization: liver disease - right hypochondrium diseases of the BT- right hypochondrium, epigastrium diseases of
5. Pain The nature and intensity of pain - any, but biliary colic is more typical for
6. Pain Provocation: - The relationship with food intake is usually determined by the nature of the
7. Pain eponymous symptoms Murphy s. Eisenberg s. Mussi s. point Bergman point Boas BT diseases Punch
8. Kerte s.– pain in pancreas proection Kach s. – hypersensitivity p. Desjardins ∆ Shoffard p. Mayo-Robson
9. Conclusion: detailing the pain can help in the diagnosis, but the diagnostic significance may be. insufficient
10. Additional syndroms Gastric dyspepsia – nonspecific Biliary dyspepsia - reflects duodenal dyskinesia, not specific Small bowel
11. Insulin deficiency is a sure sign of β-cell damage Inflammatory Syndrome – Nonspecific Jaundice and cholestasis
12. Hepatocellular failure syndrome - significantly increases the likelihood of liver pathology, especially the presence of signs
13. Hepatocellular failure syndrome Teleangiectasia Jaundice Edema muscular atrophy hemorrhages (1972) vitamin K dependent clotting factors –
14. Portal Hypertension Syndrome is an accurate but late sign of probable liver disease The reason is
19. Lab test syndromes For L-B-P pathology - hyperbilirubinemia (conjugated, unconjugated, mixed) Inflammatory syndrome anemic cholestasis (ALP,
20. Lab test syndromes With liver diseases: HCFS (total protein, albumin, cholesterol, INR) Cytolysis (increase in AST,
21. For diseases of the pancreas: inflammatory-necrotic (amylase, lipase, trypsin in the blood) exocrine insufficiency = Malabsorption
22. Ultrasound of the abdominal cavity Liver pathology exclusion of focal pathology, detection of ascites, hepato-splenomegaly, portal
23. Endoscopy Esophagus varices Duodenopapilloscopy
24. X-ray CT MRI PET
25. N liver
26. Echinococcosis cyst
27. uneven surface ascites High density
29. CT
31. MRI cholangiography
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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

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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

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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

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Pain eponymous symptoms
Murphy s.
Eisenberg s.
Mussi s.
point Bergman
point Boas
BT diseases
Punch tenderness in

right upper quadrant

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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

Pancreas diseases:

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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

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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

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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

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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

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

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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)

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

GGTP)

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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)

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For diseases of the pancreas:
inflammatory-necrotic (amylase, lipase, trypsin in the blood)
exocrine

insufficiency = Malabsorption
insuline insufficiency (hyperglycemia, low c-peptide levels)

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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

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Endoscopy
Esophagus varices
Duodenopapilloscopy

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X-ray
CT
MRI
PET

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N liver

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Echinococcosis cyst

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uneven surface
ascites
High density

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CT

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MRI cholangiography

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

Содержание

PainLocalization:liver disease - right hypochondriumdiseases of the BT- right hypochondrium, epigastriumdiseases

PainThe nature and intensity of pain - any, but biliary colic

PainProvocation: - The relationship with food intake is usually determined by

Pain eponymous symptomsMurphy s.Eisenberg s.Mussi s.point Bergmanpoint BoasBT diseasesPunch tenderness in

Kerte s.– pain in pancreas proectionKach s. – hypersensitivityp. Desjardins∆ Shoffardp.

Conclusion: detailing the pain can help in the diagnosis, but the

Additional syndromsGastric dyspepsia – nonspecificBiliary dyspepsia - reflects duodenal dyskinesia, not

Insulin deficiency is a sure sign of β-cell damageInflammatory Syndrome –

Hepatocellular failure syndrome - significantly increases the likelihood of liver

Hepatocellular failure syndromeTeleangiectasiaJaundiceEdemamuscular atrophyhemorrhages (1972)vitamin K dependent clotting factors – 2-7-9-10