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 EMQ 27



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EMQ: 27


a)      Viral hepatitis

b)      Cirrhosis of the liver

c)      Gilbertís syndrome

d)      Carcinoma head of pancreas

e)      Hepatoma

f)        Common bile duct stones

g)      Primary biliary cirrhosis 

h)      Primary sclerosing cholangitis

i)        Malaria

j)        Liver metastases

1) A 65-year-old male complains of yellow discolouration of his eyes. He complains of passing dark urine and on direct questioning says that his stools are pale. He has a poor appetite and has lost weight. He denies any abdominal pain.

On examination he appears to have lost weight but there are no other abnormalities.

2) A 24-year-old university student who has returned from a backpacking holiday in India presents with fever, abdominal discomfort and passage of dark urine of several days duration.

On examination his sclera is icteric, there is 3 fingerbreadths tender hepatomegaly.

3) A 55-year-old obese female presents with a history of colicky right hypochondrial pain. The pain subsides but she notices yellow discolouration of her eyes. On direct questioning she reveals that her urine is dark in colour and her stools are pale.

She is a dinner lady at a school, married and has 5 children.

On examination she is obese, has fever and is tender over the right hypochondrium.

4) A 60-year-old male presents with yellow discolouration of his eyes. He gives a history of altered bowel habit with alternating constipation and loose motions of several months duration. Recently he has noticed that he has passed some blood in his stool.

On examination he appears unwell, abdominal examination reveals an enlarged liver that is hard in consistency and the surface of the liver is irregular. A bruit is heard over it.

5) A 36-year-old male who is known to have ulcerative colitis, which is well controlled on Asacol 800 mgs t.d.s. presents with fever, abdominal pain, itching and yellow discolouration of his skin .

On examination he is febrile, jaundiced and has hepatosplenomegaly.


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