Category Archives: Hepatobiliary Surgery

Main Clinical Manifestations of Hepatic Abscess

Hepatic abscess is a focal collection of pus within the liver parenchyma, most frequently bacterial (pyogenic) or amoebic in origin. Clinical expression reflects the host response, abscess size, number, and the presence of systemic dissemination. Recognition of the evolving pattern is essential for early drainage and antimicrobial therapy. High-grade fever with rigorsSpiking temperature > 38.5 °C, often accompanied by chills and profuse sweating, is the hallmark of intrahepatic infection and may precede localising symptoms by several days. Right-upper-quadrain painA constant dull ache or pleuritic pain under the costal margin is typical; larger abscesses produce a boring sensation that radiates to... Learn more

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  4. Main Clinical Manifestations of Extrahepatic Bile-Duct Stones
  5. Main Clinical Manifestations of Acute Cholecystitis
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Main Clinical Manifestations of Hepatic Rupture

Hepatic rupture is an acute disruption of liver parenchyma that may follow blunt trauma, penetrating injury, spontaneous bleeding from tumours, or iatrogenic insults during percutaneous procedures. Clinical expression ranges from contained subcapsular haematoma to massive intraperitoneal haemorrhage and haemodynamic collapse. Recognition of the constellation below is essential for rapid intervention. Acute abdominal painSudden, severe right-upper-quadrain pain often radiates to the shoulder tip (phrenic nerve irritation) and is exacerbated by movement, coughing, or deep inspiration. Peritoneal irritationBlood and bile extravasate onto the peritoneal surface, producing guarding, rebound tenderness and board-like rigidity. Shoulder-tip pain may dominate when the patient is supine. Hypovolaemic... Learn more

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Main Clinical Manifestations of Extrahepatic Bile-Duct Stones

Extrahepatic bile-duct stones (choledocholithiasis) are most frequently cholesterol calculi that have migrated from the gallbladder, or primary pigment stones that form de novo within the common bile duct. Symptoms depend on the degree of obstruction, the presence of infection, and the duration of bile stasis. Biliary colicEpigastric or right-upper-quadrain pain begins 30–60 min after a fatty meal, builds steadily for ≥30 min, may last several hours, and radiates to the right scapula or inter-scapular region. Movement does not relieve the discomfort, and antacids are ineffective. Nausea and vomitingGastric stasis and vagal reflexes produce repeated retching that may transiently lessen pain.... Learn more

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  5. Main Clinical Manifestations of Hepatic Abscess
  6. Main Clinical Manifestations of Hepatic Ascites

Main Clinical Manifestations of Hepatic Hydatid Disease

Hepatic hydatid disease (hepatic echinococcosis) is a zoonotic infection caused by the larval stage of Echinococcus granulosus or E. multilocularis. Its presentation is dictated by cyst number, size, location, integrity, and associated complications. Many patients remain asymptomatic for years; symptoms emerge only when growing cysts exert a mass effect, rupture, or become secondarily infected. Pain and right-upper-quadrant discomfortA constant dull ache or sensation of fullness develops beneath the costal margin as the cyst expands or stretches Glisson’s capsule; sudden sharp pain heralds cyst rupture or intracystic haemorrhage. Palpable hepatic massInspection reveals asymmetric abdominal bulging; palpation detects a smooth, resilient, ballotable... Learn more

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What Are the Symptoms of Intrahepatic Biliary Calculi?

Intrahepatic biliary calculi (hepatolithiasis) are stones that form within the liver’s intrahepatic bile ducts. Most small or segmental stones are silent; symptoms appear when stones obstruct flow, provoke cholangitis, or lead to secondary biliary cirrhosis. Right-upper-quadrant painDull or colicky ache under the ribs, often recurrent and triggered by fatty meals; may radiate to the back or right shoulder. Cholangitis attacksIntermittent fever with chills, shaking rigors, and raised right-sided tenderness (Charcot triad) when stones block a segmental duct and become infected. JaundiceFluctuating yellowing of sclera and skin, dark urine, and pale stools occur as stones impact major intra-hepatic radicals or cause... Learn more

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