Category Archives: Hepatobiliary Surgery

What Are the Symptoms of Liver Tumors?

Liver tumors—benign or malignant—may remain silent while small. As they enlarge or metastasize, the following complaints commonly appear:

Right-upper-quadrant pain or heaviness
A dull, continuous ache or dragging sensation under the ribs is the most frequent early symptom; sudden severe pain suggests bleeding into the tumor or capsule rupture.
Palpable mass or abdominal swelling
Patients often notice a firm, non-tender lump or increasing girth caused by hepatomegaly or ascites.
Unintended weight loss & anorexia
Rapid loss of >5 % body weight, early satiety and food aversion reflect high tumour metabolism and cytokine release.
Fatigue and weakness
Persistent tiredness disproportionate to activity is common in both primary and secondary liver cancers.
Jaundice
Yellow sclera/skin, dark urine and pale stools occur when tumour compression, bile-duct invasion or extensive parenchymal replacement impairs bilirubin excretion.
Fever & night sweats
Low-grade, intermittent pyrexia results from tumour necrosis or inflammatory cytokines.
Gastro-intestinal bleeding
Portal hypertension from tumour thrombosis may precipitate haematemesis or melaena via ruptured oesophageal varices.
Acute deterioration
Hypotension, tachycardia and anaemia herald intraperitoneal haemorrhage from a ruptured nodule—an oncologic emergency.

Because early findings overlap with benign liver disease, any new combination of RUQ pain, weight loss and fatigue, especially in patients with cirrhosis or chronic hepatitis, warrants urgent imaging and tumour-marker assessment.

Symptom / Sign	Typical Features
RUQ pain/heaviness	Dull ache, worse on movement
Palpable mass	Firm, non-tender, moves with respiration
Weight loss	>5 % in weeks, anorexia
Fatigue	Persistent, disproportionate
Jaundice	Yellow sclera, dark urine, pale stools
Fever	Low-grade, intermittent
GI bleeding	Haematemesis, melaena
Acute deterioration	Shock, anaemia → rupture/haemorrhage

What Are the Symptoms of Liver Hemangioma?

A liver hemangioma is the most common benign hepatic tumor, formed by malformed blood-filled vessels. Most lesions are small (<5 cm) and discovered incidentally during imaging for unrelated problems; they remain asymptomatic throughout life. Symptoms, when present, relate to large size, rapid growth, or complications such as thrombosis, bleeding, or pressure on neighboring structures.

Right-upper-quadrant discomfort
Dull, persistent pain or fullness under the ribs is the usual complaint, often exacerbated after large meals or prolonged sitting .
Nausea, early satiety, bloating
A bulky hemangioma can compress the stomach and duodenum, leading to rapid fullness, eructation, and occasional vomiting .
Poor appetite and weight loss
Chronic discomfort and early satiety may reduce oral intake, resulting in mild cachexia over time.
Jaundice (rare)
Obstruction of intra-hepatic bile ducts by a centrally located or pedunculated tumor can elevate conjugated bilirubin, producing scleral icterus and dark urine .
Acute pain with bleeding or rupture
Sudden severe pain, hypotension, and anemia signify hemorrhage into the lesion or intraperitoneal rupture—an emergency requiring immediate care .
Fever and inflammatory markers
Thrombosis within the hemangioma or secondary inflammation can cause low-grade fever and elevated C-reactive protein without infection.

Because most lesions remain stable, any new or worsening symptom in a patient with a known hemangioma should prompt repeat imaging to assess for enlargement or complications.

Symptom / Sign	Typical Features
RUQ discomfort	Dull ache, fullness, post-prandial
Nausea & early satiety	Large mass compresses stomach
Weight loss	Secondary to reduced intake
Jaundice	Rare, due to bile-duct compression
Acute pain + shock	Bleeding or rupture
Fever	Thrombosis/inflammation

What Are the Symptoms of Pancreatic Endocrine Tumors?

Pancreatic endocrine tumors (PETs) are rare neoplasms that arise from the hormone-secreting cells of the pancreas. They can be classified as either functional (hormone-secreting) or non-functional (non-hormone-secreting). The symptoms depend on the type of hormone produced and the size or location of the tumor.

Insulin-secreting tumors (Insulinomas)
- Episodes of hypoglycemia (low blood sugar), especially during fasting or after exercise
- Symptoms include sweating, palpitations, tremors, confusion, blurred vision, and loss of consciousness
- Relief of symptoms after glucose intake is typical
Gastrin-secreting tumors (Gastrinomas)
- Recurrent peptic ulcers, often multiple or refractory to treatment
- Abdominal pain, heartburn, nausea, and vomiting
- Diarrhea due to excess acid production
Glucagon-secreting tumors (Glucagonomas)
- Skin rash (necrolytic migratory erythema), especially on the face, abdomen, and limbs
- Weight loss, anemia, diabetes mellitus, and deep vein thrombosis
VIP-secreting tumors (VIPomas)
- Profuse watery diarrhea leading to dehydration and electrolyte imbalance
- Flushing, low blood potassium, and metabolic acidosis
Somatostatin-secreting tumors (Somatostatinomas)
- Diabetes mellitus, gallstones, diarrhea, and steatorrhea
- Weight loss and abdominal pain
Non-functional tumors
- Often asymptomatic in early stages
- Symptoms appear when the tumor grows large enough to compress nearby organs
- These may include abdominal pain, weight loss, jaundice, nausea, or a palpable mass
General tumor-related symptoms
- Fatigue, loss of appetite, unexplained weight loss, and low-grade fever

Hormone Type	Key Symptoms
Insulin	Hypoglycemia, sweating, confusion, loss of consciousness
Gastrin	Peptic ulcers, abdominal pain, diarrhea
Glucagon	Skin rash, weight loss, diabetes, anemia
VIP	Watery diarrhea, flushing, low potassium
Somatostatin	Diabetes, gallstones, diarrhea, weight loss
Non-functional	Abdominal pain, jaundice, weight loss, mass effect

What Are the Symptoms of Cholangiocarcinoma?

Cholangiocarcinoma (bile-duct cancer) is anatomically classified into intra-hepatic, peri-hilar and distal types. Early findings are usually non-specific; symptoms depend on where the tumour grows and how quickly it obstructs bile flow.

Painless jaundice
Yellow discoloration of skin and sclera plus dark urine and clay-coloured stools is the hallmark of peri-hilar or distal tumours that occlude the main bile ducts .
Generalised pruritus
Deposition of bile salts in the dermis produces intense, often intractable itching that may precede visible jaundice.
Right-upper-quadrant pain
A dull, non-colicky ache or sense of fullness develops as the mass enlarges or as the gall-bladder and liver capsule become stretched.
Systemic features
Fatigue, anorexia, low-grade fever and night sweats are common, while unexplained weight loss reflects tumour cachexia and reduced oral intake .
Acute cholangitis picture
Fluctuating fever with rigors, hypotension and confusion may occur if malignant obstruction becomes super-infected.
Intra-hepatic variant
Tumours within the liver parenchyma seldom obstruct major ducts early; they present with vague upper-abdominal discomfort, fatigue and weight loss, with jaundice appearing only late if at all .

Because early symptoms overlap with benign biliary disease, any new combination of jaundice, pruritus and weight loss—especially in patients over 50 or those with primary sclerosing cholangitis—should prompt urgent imaging and laboratory work-up.

Symptom	Typical Presentation
Painless jaundice	Yellow skin/sclera, dark urine, pale stools
Pruritus	Intense, may precede jaundice
RUQ pain/Fullness	Dull, non-colicky ache
Weight loss & fatigue	Rapid, unintended
Fever & night sweats	Low-grade, intermittent
Acute cholangitis	Rigors, hypotension, mental change

What Are the Symptoms of Gallbladder Polyps?

Most gallbladder polyps are found by chance and produce no symptoms at all, especially when smaller than 6 mm. When complaints do occur they are usually caused by the polyp obstructing the cystic duct, by associated gallstones, or by detachment of cholesterol fragments that behave like microliths.

Episodic right-upper-quadrant pain
A dull or colicky ache begins 30–60 min after a fatty meal, may last several hours and can radiate to the right scapula—mimicking classic biliary colic.
Nausea and occasional vomiting
Gastric stasis and bile-duct spasm produce queasiness; vomiting may relieve the discomfort.
Dyspepsia and bloating
Patients report early satiety, eructation, or vague upper-abdominal heaviness unrelated to meals.
Jaundice (rare)
A large polyp that prolapses into the common bile duct can cause conjugated hyper-bilirubinaemia with dark urine and pale stools.
Acute cholecystitis picture
Continuous pain, local tenderness, low-grade fever and leukocytosis develop if the polyp blocks the cystic neck and precipitates inflammation.
Pancreatitis or hemobilia (very rare)
Transient obstruction of the pancreatic duct or bleeding from a friable polyp can produce epigastric pain radiating to the back or melena.

Because symptoms overlap with gallstone disease, any new biliary-type pain in a patient known to carry polyps should prompt repeat imaging to look for growth or co-existing stones.

Symptom	Typical Presentation
RUQ colic	Post-prandial, radiates to scapula
Nausea/bloating	Early satiety, eructation
Jaundice	Large polyp blocks bile duct
Acute cholecystitis	Constant pain, fever, Murphy sign
Pancreatitis	Epigastric pain ↑ amylase
Hemobilia	Upper GI bleeding, melena

What Are the Symptoms of Gallstones?

Gallstones often remain silent for years. Symptoms appear only when a stone obstructs the cystic or common bile duct, triggering the well-defined attacks described below.

Biliary colic
Sudden, crampy pain arises in the right hypochondrium or epigastrium, builds steadily for 15–30 min, and may last several hours. It radiates to the right scapula, shoulder, or between the shoulder blades and is typically provoked by a fatty meal or occurs at night .
Nausea and vomiting
Gastric stasis and bile-duct spasm produce pronounced nausea; vomiting may partially relieve the pain .
Intolerance to fatty foods
Patients report early satiety, bloating, eructation, or loose stools after meals rich in fat.
Low-grade fever & chills
Afebrile colic is usual, but temperature 37.5–38 °C with chills suggests acute cholecystitis or cholangitis .
Jaundice & pigment changes
Obstruction of the common bile duct elevates conjugated bilirubin, producing scleral icterus, dark urine, and clay-coloured stools .
Cardiovascular accompaniments
Tachycardia and reflex vasovagal sweating are common during intense pain .
Alarm features
Pain persisting >6 h, unrelenting vomiting, high fever, hypotension, or confusion indicates complications such as empyema, gangrene, pancreatitis, or ascending cholangitis and mandates urgent care .

Symptom	Typical Features
Biliary colic	RUQ/epigastric pain, peaks 15–30 min, radiates to back/shoulder
Nausea/vomiting	Frequent, may relieve pain
Fat intolerance	Bloating, eructation, loose stools
Fever & chills	Low-grade in cholecystitis; high with cholangitis
Jaundice	Yellow sclera, dark urine, pale stools
Tachycardia/sweating	Reflex response to severe pain
Alarm signs	Pain >6 h, high fever, hypotension → complications

What Are the Symptoms of Liver Cancer?

Liver cancer—predominantly hepatocellular carcinoma (HCC)—often begins silently; early-stage tumours rarely cause pain or obvious changes. As the lesion enlarges or invades adjacent structures, the following complaints typically appear:

Right-upper-quadrant discomfort
A dull, continuous ache or heaviness develops beneath the ribs and may radiate to the back or right shoulder.
Palpable mass or swelling
Patients or clinicians can feel a firm, nodular liver edge below the costal margin; progressive enlargement can produce visible asymmetry of the abdomen.
Unintended weight loss & anorexia
Rapid loss of >5 % body weight within weeks, early satiety and loss of interest in food are common systemic effects.
Fatigue and weakness
Persistent tiredness unrelated to exertion reflects both malignant cachexia and underlying chronic liver disease.
Jaundice
Yellow discoloration of sclerae and skin arises when tumour compression or portal vein invasion reduces bilirubin excretion.
Ascites & peripheral oedema
Fluid accumulates in the peritoneal cavity and ankles as portal hypertension and hypoalbuminaemia worsen.
Pyrexia & night sweats
Low-grade fever is present in ~30 % of cases, probably due to cytokine release or central tumour necrosis.
GI bleeding
Ruptured oesophageal or gastric varices may cause haematemesis or melaena when portal pressure rises.
Paraneoplastic signs
Hypercalcaemia, hypoglycaemia, erythrocytosis or cutaneous lesions (e.g., dermatomyositis) occasionally precede other manifestations.

Symptoms are often indistinguishable from decompensated cirrhosis; any new or worsening complaint in a cirrhotic patient warrants immediate imaging and tumour-marker assessment.

Symptom / Sign	Typical Features
RUQ pain/heaviness	Dull ache, may radiate to shoulder
Palpable liver mass	Firm, nodular, expands downwards
Weight loss & anorexia	>5 % loss, early satiety
Fatigue	Persistent, disproportionate
Jaundice	Yellow sclera/skin, dark urine
Ascites/oedema	Bulging flanks, ankle swelling
Fever	Low-grade, night sweats
GI bleeding	Haematemesis, melaena
Paraneoplastic	Hypoglycaemia, skin rash

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Category Archives: Hepatobiliary Surgery

What Are the Symptoms of Liver Tumors?

What Are the Symptoms of Liver Hemangioma?

What Are the Symptoms of Pancreatic Endocrine Tumors?

What Are the Symptoms of Cholangiocarcinoma?

What Are the Symptoms of Gallbladder Polyps?

What Are the Symptoms of Gallstones?

What Are the Symptoms of Liver Cancer?

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