Main Clinical Manifestations of Bile-Duct Stones

Choledocholithiasis denotes the presence of calculi within the extra- or intrahepatic bile ducts. Symptoms arise when a stone obstructs flow, triggers inflammation, or provokes infection. The presentation ranges from silent imaging findings to life-threatening sepsis. Biliary colicEpigastric or right-upper-quadrant pain begins 30–60 min post-prandially, peaks for ≥30 min, and radiates to the inter-scapular region or right shoulder. Movement does not relieve the discomfort, and analgesics are often required. Nausea and vomitingGastric stasis and vagal reflexes produce repeated retching that may transiently lessen pain. Fluctuating jaundiceIntermittent elevation of conjugated bilirubin produces scleral icterus, dark urine, and clay-coloured stools that wax and... Learn more

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Main Clinical Manifestations of Cholangitis

Cholangitis denotes acute bacterial infection within the biliary tree, most commonly precipitated by obstruction from stones, strictures, or neoplasia. The spectrum ranges from mild ductal inflammation to life-threatening sepsis. Recognition of its cardinal features guides urgent biliary decompression and antimicrobial therapy. Complication warningsPersistent fever despite antibiotics, uncontrolled hypotension, or new-onset renal dysfunction suggests progressive sepsis and requires urgent endoscopic or percutaneous biliary drainage. Charcot triadIntermittent high spiking fever with rigors, constant right-upper-quadrant pain, and conjugated hyper-bilirubinaemia constitute the classical presentation seen in ~70 % of patients with incomplete or partial obstruction. Reynolds pentadAddition of hypotension (systolic BP < 90 mmHg)... Learn more

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Main Clinical Manifestations of Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma (Klatskin tumour) arises at or near the confluence of the right and left hepatic ducts. Because the lesion obstructs the central bile ducts early, symptoms are usually biliary and appear while the tumour is still relatively small. Painless jaundiceConjugated hyper-bilirubinaemia develops insidiously, producing progressive yellowing of skin and sclera, dark urine and clay-coloured stools; pruritus is often intense and may precede visible icterus. Right-upper-quadrant discomfortA dull, non-colicky ache or sensation of fullness is common; pain is usually mild and does not parallel the degree of jaundice. Cholangitis episodesIntermittent fever with rigors, right-sided tenderness and elevated C-reactive protein occur... Learn more

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Main Clinical Manifestations of Hepatic Ascites

Ascites is the pathological accumulation of fluid within the peritoneal cavity secondary to portal hypertension, hypoalbuminaemia and sodium retention. In patients with chronic liver disease it marks the transition from compensated to decompensated cirrhosis. The severity ranges from mild, detected only by imaging, to gross, producing marked physical and metabolic disturbances. Metabolic disturbancesHyponatraemia, muscle cramps and hypervolaemic dilutional anaemia reflect advanced renal sodium retention and impaired free-water clearance. Progressive abdominal distensionPainless increase in girth is usually the first complaint; patients note tight clothing, difficulty bending forward, and a sensation of heaviness in the flanks. Shifting dullness and fluid thrillOn percussion,... Learn more

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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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