Page 188 - Medicine and Surgery

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Hepatic, biliary and 5

pancreatic systems

Clinical, 184 Disorders of the gallbladder, 215
Disorders of the liver, 192 Disorders of the pancreas, 218

(postprandial) or at night and the pain usually lasts
Clinical up to 2 or 3 hours without relief except with strong
analgesia. Associated features commonly include nau-
sea, vomiting and sweating. Jaundice occurs in about
Symptoms
a fifth of patients.
Acute cholecystitis, when the gallbladder becomes in-
Pain from the liver, biliary
and pancreatic systems flamed due to infection, causes more well-localised,
constant pain as the parietal peritoneum becomes in-
Pain originating from the liver, biliary tree or pancreas volved. The patient complains of pain in the right
is usually felt in the upper third of the abdomen. The hypochondrium, which often radiates to the right
features of the pain that should be elicited in the his- shoulder tip. The pain is exacerbated by movement
tory are the same as those for abdominal pain (see and breathing and persists until analgesia is given,
page 139). and the underlying cause is treated. Unlike biliary
colic, the pain lasts more than 3 hours. Associ-
Pain from the liver ated symptoms include fever, nausea, vomiting and
This is usually felt in the right upper quadrant of the ab- anorexia.
domen, right loin or epigastrium. It may radiate through Gallstones may also cause postprandial indigestion or
to the back. The pain is due to stretching of the liver pain, usually with an onset up to half an hour after
capsule following recent swelling of the liver, as caused eating,lasting30minutesto1.5hours.Itisoftenworse
by right heart failure and acute viral or alcohol-induced afterfattyfoods,andsymptomsmayrecuroverseveral
hepatitis.Itistypicallyadull,constant,achingpain.Liver months to years (see also page 215).
metastases may also cause pain as a presenting feature,
especially in later stages. Associated symptoms may in- Pain from the pancreas
clude nausea and jaundice. Inflammation of the pancreas, as occurs in acute pan-
creatitis (see page 218), causes epigastric pain which is
Pain from the gallbladder and biliary tree often sudden in onset, constant and increasing in sever-
Biliary colic is the term used to describe the pain due ity. The pain may radiate through to the back and to-

to obstruction of the biliary system, for example by a wards the left shoulder. Movement and lying down ex-
stone. The patient complains of very severe constant acerbate the pain and characteristically patients prefer to
pain with excruciating colicky spasms felt in the upper sit up and lean forwards. Commonly there is persistent
abdomen, which may radiate to the back or right sub- nausea, with retching and vomiting. Strong analgesia is
scapularregion.Theonsetissudden,oftenafterameal required.

184