27 topics with concise reviews: definitions, key facts, and class questions.
In this section, we cover the basics of diagnosing diseases of the hepatobiliary system and spleen. You will learn how to properly take a patient history, evaluate specific complaints, and perform a physical examination: from visual inspection to the subtleties of percussion and palpation of the liver, gallbladder, and spleen.
The material covers laboratory and instrumental diagnostics, as well as key clinical syndromes: jaundice (with a detailed classification of hyperbilirubinemias), portal hypertension, hepatocellular insufficiency, and hepatorenal and hepatosplenic syndromes. A separate block is dedicated to specific pathologies. We will analyze the clinical presentation of acute and chronic hepatitis, liver cirrhosis, alcoholic liver disease, and cancer, as well as biliary tract pathology—cholelithiasis, mechanisms of biliary colic, and cholecystitis.
Pay special attention to practical skills: during classes and exams, Kurlov's liver span, palpation techniques, and the differential diagnosis of types of jaundice based on laboratory parameters are tested most rigorously. This section will help organize theory and clinical practice in your mind.
Dark urine combined with acholia (clay-colored stools) indicates impaired bile outflow or liver parenchyma damage, requiring the exclusion of viral, toxic, or hereditary hepatitis.
What is the main difference between Gilbert's syndrome and Crigler-Najjar syndrome?
In Gilbert syndrome, there is only a partial deficiency of the enzyme UDP-glucuronosyltransferase, so the course of the disease is benign. In Crigler-Najjar syndrome, this enzyme is completely absent, causing a severe condition with a risk of bilirubin encephalopathy.
How to distinguish uncomplicated colic from acute cholecystitis?
For "pure" biliary colic without concurrent inflammation of the gallbladder wall, a high body temperature and leukocytosis in the blood test are not characteristic.
What is the main difference between hemochromatosis and hemosiderosis?
Hereditary hemochromatosis is primary and caused by genetic hypersorption of iron in the intestine. Secondary hemosiderosis occurs as a consequence of other conditions, such as frequent blood transfusions in anemias or against the background of alcoholic liver disease.
What is the characteristic feature of vomiting in biliary colic?
Unlike many other gastrointestinal diseases, vomiting in biliary colic does not bring relief to the patient.
Why do bruising and bleeding occur in cirrhosis?
Hemorrhagic syndrome occurs because the damaged liver stops synthesizing clotting factors (primarily prothrombin). Additionally, the situation is aggravated by thrombocytopenia associated with hypersplenism.
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