ACHALASIA CARDIA
It is an esophageal motility disorder characterized by the absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing.
Essentials of Diagnosis
- Dysphagia, initially intermittent with food apparently sticking at the level of xiphoid cartilage, associated with retrosternal discomfort.
- Regurgitation immediately following ingestion and delayed regurgitation in chronic cases.
- Cough and dyspnea due to pressure of dilated esophagus on trachea and bronchi.
- Aspiration of material to tracheobronchial tree may cause bronchiectasis, lung abscess or pulmonary fibrosis.
- Barium meal shows conical tapering of distal esophagus (dilation of the esophagus, a narrow esophagogastric junction with ‘bird-beak’ appearance) and fluoroscopy shows ineffectual and purposeless peristalsis with dilatation.
ACUTE CHOLECYSTITIS
It is inflammation of the gallbladder that develops over hours, usually because a gallstone obstructs the cystic duct.
Essentials of Diagnosis
- Constant, severe pain and tenderness in right hypochondrium or epigastrium.
- Nausea, vomiting, fever, chills.
- Jaundice.
- Positive Murphy's sign.
- Transabdominal ultrasonography is the best test to detect gallstones.
- Cholescintigraphy if ultrasonography results are doubtful or if acalculous cholecystitis is suspected.
- Plain X-ray shows gallstones in 15% cases.
ACUTE GASTRITIS
It is a sudden inflammation or swelling in the lining of the stomach.
Essentials of Diagnosis
- Anorexia, epigastric fullness, nausea.
- Diarrhea, colic, hematemesis, fever, chills, headache and malaise are common when caused due to toxins or infections.
- Epigastric tenderness present.
- Endoscopy differentiates acute simple gastritis from erosive gastritis, peptic ulcer or a mucosal laceration (Mallory-Weiss syndrome).
- Biopsy to exclude other causes.
ACUTE MESENTERIC LYMPHADENITIS
It refers to inflammation of the mesenteric lymph nodes.
Essentials of Diagnosis
- Acute pain around umbilicus or right iliac fossa in a child.
- Anorexia, nausea, vomiting, fever.
- Tenderness in right iliac fossa without any signs of peritoneal irritation.
- Voluntary guarding rather than abdominal rigidity.
- Marked leukocytosis.
- History of recent or current upper respiratory infection.
- History of ingestion of raw pork in areas with endemic Yersinia (e.g. Belgium).
ACUTE ORGANIC SMALL BOWEL OBSTRUCTION
It is defined as mechanical obstruction of the small bowel that prevents normal transit of the products of digestion.
Essentials of Diagnosis
- Colicky abdominal pain, vomiting, constipation borbory-gmus.
- Tender distended abdomen.
- Audible peristalsis.
- X-ray evidence of gas or multiple gas and fluid levels without movement of gas.
- Little or no leukocytosis.
ACUTE PANCREATITIS
It is a sudden inflammation of pancreas where the pancreatic enzymes autodigest the gland.
Essentials of Diagnosis
- Sudden, severe epigastric pain with radiation to back in an alcoholic or in those with known biliary disease.
- Fainting attacks, sweating, vomiting.
- Fever, leukocytosis, paralytic ileus in some patients.
- Imaging studies may be done when the diagnosis is in doubt, when severe pancreatitis is present.
- Elevated serum, urinary amylase and lipase.
ALCOHOLIC HEPATITIS
Alcoholic hepatitis or inflammation of the liver is due to excessive intake of alcohol. It is usually found in association with fatty liver, an early stage of alcoholic liver disease and may contribute to the progression of fibrosis, leading to cirrhosis.
Essentials of Diagnosis
- Anorexia, nausea, abdominal discomfort in a patient after a recent period of heavy drinking.
- Tender hepatomegaly and often jaundice.
- Fever, splenomegaly, ascites, encephalopathy, abdominal pain and tenderness when present, further support the diagnosis.
- Elevated serum alkaline phosphatase (rarely more than three times of normal value). Increased SGOT, serum bilirubin, elevated serum globulin and depressed albumin.
- Liver biopsy is confirmatory.
AMEBIASIS (Intestinal Amebiasis)
It is the parasitic infestation of the intestines caused by the protozoan Entamoeba histolytica or E. histolytica.
Essentials of Diagnosis
- Frequent passage of loose offensive stool, often mixed with blood and mucus.
- Abdominal cramps.
- Gaseous distention, vague abdominal pain often with insomnia and depression.
- A sensation of incomplete clearance of bowel even after frequent stool.
- Frequent stools with offensive gangrenous sloughs, dark blood, pus, prostration and dehydration in fulminant cases.
- Hematophagous amebas in stool are diagnostic, cysts in the stool are evidence of quiescent infection.
- Sigmoidoscopy shows flask shaped ulcers, raised button like ulcers or mouse eaten appearance.
ANAL FISSURE
An anal fissure is a tear in the lining of the anal canal that causes pain during bowel movements.
Essentials of Diagnosis
- Acute pain during and after defecation.
- Bright red blood with stool.
- Tendency for constipation due to fear of pain.
APHTHOUS STOMATITIS
It is characterized by the recurrent benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals.
Essentials of Diagnosis
- They are covered with a yellow-grey fibrinous membrane that can be scraped away.
- An erythematous ‘halo’ surrounds the ulcer.
- Often painful and usually recurrent.
- May be associated with inflammatory bowel disease, prolonged fever, infectious mononucleosis, history of emotional stress.
APPENDICITIS
It is defined as an inflammation of the inner lining of the appendix that spreads to its other parts.14
Essentials of Diagnosis
- Pain and tenderness in right iliac fossa with signs of peritoneal irritation (muscle guard and positive Rovsing's sign).
- Low grade fever, vomiting, constipation.
- CRP (C-reactive protein) levels >1 mg/dL are common.
- HIAA (hydroxyindoleacetic acid) levels increase significantly in acute appendicitis; a decrease indicates perforation.
- Polymorphonuclear leukocytosis.
- Rectal tenderness is common in pelvic appendicitis; psoas and obturator signs are positive. X-ray abdomen shows radiopaque shadow consistent with fecolith in the appendix area.
- CT scan and ultrasonography may be helpful in atypical presentations.
- In infants and aged, the prodromal symptoms as well as localized signs are minimum until perforation occurs.
- Tender mass in the iliac fossa with continuous fever, malaise, toxicity and marked leukocytosis indicate appendicular abscess. Pelvic abscess tends to protrude into vagina/rectum.
Appendicular Mass
It is an inflamed appendix with glutinous covering of omentum and small bowel. Its history is almost the same to that of appendicitis with a longer duration since onset. Examination shows a mass in the right iliac fossa.
BACILLARY DYSENTERY
It is associated with species of bacteria from the Enterobacteriaceae family; the term is usually restricted to Shigella infections. It should not be confused with bacterial diarrhea as bacillary dysentery is characterized by blood in stool.16
Essentials of Diagnosis
- Frequent stools with blood and muocus (Red currant jelly).
- Abdominal cramps.
- Fever, malaise and prostration.
- Pus in stool.
- Organisms isolated on stool culture.
BOTULISM
It is a rare and potentially fatal illness caused by a toxin produced by the bacterium Clostridium botulinum.
Essentials of Diagnosis
- History of recent ingestion of home canned or unusual foods.
- Toxin demonstrated in the food by mouse inoculation and identified with specific antisera.
CANCER COLON
Cancer in the colon is due to abnormal growth of cells that have the ability to invade or spread to other parts of the body. Risk factors include lifestyle, old age and inherited genetic disorders. Other risk factors includes diet, smoking, alcohol, lack of physical activity, family history of colon cancer and colon polyps, presence of colon polyps, race, exposure to radiation and even other diseases such as diabetes and obesity.18
Essentials of Diagnosis
- Blood in the feces, anemia, asthenia.
- Palpable colonic mass (especially in ascending colon).
- Altered bowel function, i.e. progressively increasing constipation (left colon) or diarrhea.
- Sigmoidoscopic and X-ray evidence of the neoplasm.
- CT scan and other imaging techniques are used to determine the extent of the disease and staging.
- Screening is recommended in high-risk cases.
CANCER ESOPHAGUS
It is cancer arising from the esophagus; the two main subtypes being squamous-cell carcinoma which is more common in the developing world and esophageal adenocarcinoma, which is more common in the developed world.
Essentials of Diagnosis
- Progressive dysphagia even to liquids.
- Chest pain—unrelated to eating implies local extension of tumor.
- Barium swallow shows irregular, frequently annular space occupying lesions.
- The diagnosis is made during an endoscopy and confirmed by biopsy.
- CT scan and other imaging techniques are helpful in staging.
- Screening in Barrett's esophagus is beneficial.
CANDIDIASIS (Thrush)
It is a fungal infection due to any type of Candida. When it affects the mouth, it is commonly called thrush.
Essentials of Diagnosis
- Pain, fever and lymphadenopathy in some cases.
- Clinical diagnosis is sufficient to start the treatment, although brushings and biopsies can be obtained for confirmation.
CARCINOMA OF LIVER
It is also called malignant hepatoma, is the most common type of liver cancer. Most cases are secondary to either a viral hepatitis infection (hepatitis B or C) or cirrhosis (alcoholism being the most common cause of liver cirrhosis).21
Essentials of Diagnosis
- Hard, enlarged, tender liver with or without palpable nodules.
- Symptoms of long-standing cirrhosis with sudden deterioration in the condition of the patient.
- Bloody ascites.
- Anemia, cachexia, hepatic bruit or friction rub.
- Alphafetoprotein (AFP) raised in 50% case of hepatoma.
- Ultrasound and CT scan.
- Liver scanning with 99mTc. Sulfur colloid and liver biopsy are confirmatory.
CARCINOMA OF STOMACH
Carcinoma of the stomach or the cancer developing in the lining of the stomach is most commonly caused by infection by the bacterium Helicobacter pylori. Other common causes include eating pickled vegetables, smoking and genetic predisposition.22
Essentials of Diagnosis
- Anemia, asthenia and anorexia in patients over 40 years of age.
- Palpable abdominal mass.
- Occult blood in stool.
- Gastroscopic and X-ray abnormality with positive cytological examination.
- The less common manifestations include post- prandial distress simulating peptic ulcer and diarrhea due to associated achlorhydria. Enlarged Virchow's (left supraclavicular) nodes, Krukenberg's tumor in female, enlarged hard nodular liver, ascites, pelvic mass and pathological fractures denote metastasis.
- Radiological findings vary according to the type of lesion, i.e. ulcerative, polypoid, infiltrating or combinations. The findings can be summarized as:
CHOLEDOCHOLITHIASIS
It is the presence of gallstones in the common bile duct.
Essentials of Diagnosis
- Sudden, severe, right upper quadrant abdominal pain radiating to scapula.
- Nausea, vomiting, fever, jaundice, leukocytosis.
- History of such recurrent attacks persisting for hours.
- Chills with gram negative shock in cases of acute suppurative cholangitis.
- Laboratory investigations show features of obstructive jaundice with hypoprothrombinemia.
- The diagnosis is confirmed with either an MRCP (mag-netic resonance cholangiopancreatography), an ERCP (endoscopic retrograde cholangiopancreatography) or an intraoperative cholangiogram.
CHOLERA
It is an infection of the small intestine by some strains of the bacterium Vibrio cholerae.
Essentials of Diagnosis
- Sudden onset of explosive diarrhea.
- Stool are gray, turbid without any fecal odor, blood or pus (rice water stool).
- Rapid development of dehydration, acidosis, hypokalemia, hypotension.
- Positive stool culture and agglutination of vibrios with specific sera.
- A rapid dipstick test is available to determine the presence of Vibrio cholerae.
CHRONIC CHOLECYSTITIS
It is a long-standing gallbladder inflammation almost due to gallstones and prior episodes of acute cholecystitis.26
Essentials of Diagnosis
- History of frequent attacks of biliary colic (i.e. right upper quadrant abdominal pain referred to right scapula).
- Flatulent dyspepsia with fatty food intolerance.
- Nonfunctioning gallbladder on IV cholecystography or presence of gallstones.
CHRONIC GASTRITIS
It refers to a persistent, but low grade inflammation and damage to the stomach lining.
Essentials of Diagnosis
- Asymptomatic or vague nondescriptive upper abdominal distress.
- Mild epigastric tenderness or no physical findings.
- Ulcer or cancer like syndrome, often with gross hematemesis.
- Gastroscopy shows mucosal atrophy as evidenced by visualization of blood vessels through mucosa.
CONSTIPATION
Patient should be considered to be constipated only if defecation is explainably delayed for days or if stools are unusually hard, dry and difficult to expel. Causes of constipation are:
- Dietary factors—highly refined or low-fiber foods, inadequate fluids.
- Physical inactivity, inadequate exercise and prolonged bed rest.
- Pregnancy.
- Advanced age.
DIVERTICULAR DISEASE OF COLON (Diverticulosis)
It is a condition in which diverticula are present in the intestine without any signs of inflammation.
Essentials of Diagnosis
- Intermittent cramping and left lower abdominal pain.
- Constipation alternating with diarrhea.
- X-ray evidence of diverticula, thickened interhaustral folds, narrowed lumen on barium enema.
- Contrast CT is the investigation of choice in acute episodes of diverticulitis and where complications exist.
DUMPING SYNDROME (Postgastrectomy Syndrome)
It is a group of symptoms, including weakness, abdominal discomfort and sometimes abnormally rapid bowel evacuation, occurring after meals in some patients who have undergone gastric surgery.30
Essentials of Diagnosis
Sweating, tachycardia, pallor, abdominal cramps, weakness and in severe cases syncope within 20 minutes of meal.
DUODENAL ULCER
An ulcer or break in the lining in the first part of the intestines is known as a duodenal ulcer.
Essentials of Diagnosis
- Epigastric pain (1/2–1 hour after meals) or nocturnal pain, both relieved by food, antacid or vomiting.
- Chronic and periodic symptoms.
- Epigastric tenderness, often with guarding and unilateral spasm of rectus over duodenal bulb.
- Pylorospasm, gastric hypermotility and irritability of the bulb with difficulty in retaining the barium are indirect evidences of duodenal ulcer.
- Gastric analysis shows acid in all cases and hypersecretion in some cases.
- Few patients may present with vague dyspepsia or typical symptoms due to anxiety.
- Direct visualization by endoscopy.
GASTRIC ULCER
An ulcer or break in the lining of the stomach is known as gastric ulcer.
Essentials of Diagnosis
- Epigastric distress, relieved by vomiting, antacid.
- Ulcer demonstrated by barium meal and X-ray or gastroscopy (edema, spasm, convergence of gastric mucosal folds).
- 90% heal in 12 weeks on medical therapy.
Gastric ulcer | Chronic duodenal ulcer | |
|---|---|---|
Pain onset | 2.5–4 hours after meals | 15 minutes to 2 hours after meals |
Sequence | Comfort-food -pain-comfort | Pain-food-comfort |
Site | Epigastrium | Right half of gastrium |
Radiation to back | Common | Rare |
Relief | Taking alkalis | After food |
Hydrochloric acid (HCl) | Normal | ++ |
Barium meal | Stomach empties slowly | Empties fast |
HEMORRHOIDS
Also called piles, hemorrhoids are swollen and inflamed veins in anus and lower rectum.
Essentials of Diagnosis
- Rectal bleeding and discomfort following defecation, protrusion and pain around anus.
- Hemorrhoids visible on anal inspection or anoscopic examination.
HERPETIC STOMATITIS
It is a viral infection (Herpes simplex) of the mouth that causes sores and ulcers.
Essentials of Diagnosis
- Common in children below 10 years.
- Severe ulceration of oral mucous membrane associated with systemic signs, i.e. fever, lymphadenopathy (cervical) and malaise.
- Cytologic smear showing pathognomonic pseudogiant cells is confirmatory.
HICCUP
It is an involuntary spasm of the diaphragm and respiratory organs, with a sudden closure of the glottis and a characteristic gulping sound.
It is a transient phenomenon and may occur as manifestation of many diseases such as neuroses, central nervous system (CNS) disorders, gastrointestinal tract (GIT) disorders, etc. It may be the only symptom of peptic esophagitis.
INTESTINAL TUBERCULOSIS
It can occur either primarily or secondary to a tuberculous focus at a different site. Primary intestinal tuberculosis caused by the bovine strain has become rare with the widespread pasteurization of milk; secondary intestinal tuberculosis is more common and is usually due to ingestion of infected sputum.37
Essentials of Diagnosis
- Fever, anorexia, nausea, flatulence, food intolerance and distension after food.
- Chronic abdominal pain varying from mild to severe cramps.
- Mild to severe diarrhea.
- Chest X-ray may show evidence of tuberculosis, but a negative X-ray does not exclude the diagnosis.
- Doughy feelings of abdomen on palpation.
- Abdominal X-ray findings according to type of lesion, i.e. irritability and spasm particularly in cecal region, irregular hypermotility of the intestinal tract, irregular filing defects (hypertrophic type of lesion) are noted. Persistent narrow beam of barium in small bowel (string sign) is seen. Biopsy and animal inoculation are confirmatory. The presence of tubercle bacilli in stool does not correlate with intestinal involvement.
IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome (IBS) or spastic colon is characterized by chronic abdominal pain, discomfort, bloating and alteration of bowel habits.
Essentials of Diagnosis
- Abdominal pain.
- Altered bowel function, constipation or diarrhea.
- Hypersecretion of colonic mucosa.
- Varying degree of anxiety or depression
- No specific laboratory or imaging test can diagnose irritable bowel syndrome. Diagnosis involves excluding conditions that produce similar symptoms and then following a procedure to categorize the patient's symptoms.
NAUSEA AND VOMITING
Nausea is an uneasiness of the stomach that often comes before vomiting. Vomiting is the forcible voluntary or involuntary emptying of stomach contents through the mouth.
Simple causes of vomiting are:
- Alimentary disorders, irritation, inflammation or mechanical disturbances at any level of GI tract.
- CNS: Increased intracranial pressure, stroke, migraine, infection, toxins and radiation sickness.
- Endocrine disorders: Diabetic acidosis, adrenocortical crisis, pregnancy, starvation, lactic acidosis.
- Drugs: Morphine, meperidine, codeine, anticancer drugs.
- Psychological disorders: Reaction to pain, fear or displeasure, chronic anxiety reaction, anorexia nervosa, psychosis.
NODULAR CIRRHOSIS
Cirrhosis of the liver is the end stage of a complex process resulting from hepatocyte injury and the response of the liver that leads to partial regeneration and fibrosis of the liver. On gross inspection, a cirrhotic liver appears nodular, ‘hub-nailed’, on the external surface and nodular on the cut surface.42
Essentials of Diagnosis
- Anorexia, weight loss, anemia, nausea, vomiting, abdominal pain, diarrhea.
- Palpable, firm liver with blunt edges.
- Ascites.
- Amenorrhea, impotence, sterility.
- Spider nevi, palmar erythema.
- Splenomegaly, jaundice in some cases.
- Gynecomastia, testicular atrophy, axillary and pectoral alopecia are additional findings.
- Pleural effusion, ankle edema, hematemesis are late findings.
- Flapping tremor, dysarthria, delirium and drowsiness are present in pre-coma state.
- Laboratory findings include bromosulphthalein retention, elevated lactate dehydrogenase (LDH), serum glutamic oxaloacetic transaminase (SGOT), alkaline phosphatase, bilirubin, decreased albumin and elevated gamma globulin.
- Liver biopsy shows diffuse fibrosis and nodular regeneration throughout the liver.
NONSPECIFIC ULCERATIVE COLITIS
It is a type of inflammatory bowel disease of unknown etiology with repeated episodes of symptoms and remission (relapsing-remitting).
Essentials of Diagnosis
- Frequent passage of blood mixed stool (bloody diarrhea).
- Spontaneous remissions and exacerbations.
- Lower abdominal cramps with mild abdominal tenderness usually on rectosigmoid area.
- Anemia, no stool pathogens.
- Barium enema and X-ray shows irritability and fuzzy margins to pseudopolyps, shortening of colon, narrowing of lumen, loss of haustral markings.
- Biopsies are taken for confirmatory diagnosis and to differentiate from Crohn's disease.
- Patients are adolescents or young adults.
PARALYTIC ILEUS (Functional Obstruction)
Essentials of Diagnosis
- Continuous abdominal pain, distension, vomiting and constipation.
- History of precipitating factors, i.e. after surgery, peritonitis.
- Minimal abdominal tenderness and decreased or absent bowel sounds.
- X-ray evidence of gas and fluid in the bowel.
PEPTIC ESOPHAGITIS
Peptic or reflux esophagitis is associated with reflux of gastric and duodenal contents into the esophagus, commonly due to incompetence of LES.48
Essentials of Diagnosis
- Retrosternal burning, pain and heaviness.
- Symptoms aggravated by recumbency or increased abdominal pressure, relieved by upright position.
- Nocturnal regurgitation with cough and dyspnea in some case.
- Hiatus hernia on X-ray.
- Common in middle aged obese females or in patients with increased intra-abdominal pressure.
- Esophagoscopy showing hyperemia and ulceration.
- Erosion when seen is confirmatory. Biopsy is mandatory to exclude malignancy.
PRIMARY BILIARY CIRRHOSIS
Essentials of Diagnosis
- Insidious onset.
- Pruritus followed by jaundice.
- Hepatosplenomegaly.
- Xanthomatous lesions around eyelids.
- Serological tests reflect cholestasis with elevated alkaline phosphatase, 5 nucleotidase, cholesterol and bilirubin.
- Serum is positive for antimitochondrial antibodies.
- Abdominal ultrasound, MR scanning magnetic resonance cholangiopancreatography (MRCP) or a CT scan is usually performed to rule out blockage to the bile ducts.
- A liver biopsy is needed to determine the stage of disease.
- Mainly in ladies of age group 40–60 years.
REGIONAL ENTERITIS (Crohn's Disease)
Regional enteritis or Crohn's disease or syndrome is a type of inflammatory bowel disease that is caused by a combination of environmental, immune and bacterial factors in genetically susceptible individuals.
Essentials of Diagnosis
- Insidious onset.
- Intermittent bouts of diarrhea, low grade fever.
- Pain, tenderness and often mass in right iliac fossa.
- Symptoms due to bowel perforation, i.e. localized abscess, internal/external fistula, peritonitis.
- Extraintestinal manifestations like:
- Arthritis, subacute migratory, asymmetrical, polyarthritis lasting for 1–2 weeks principally involving knees and ankles.
- Erythema nodosum.
- Uveitis.
- Colonoscopy can effectively diagnose the disease in 70% of cases.
- Capsule endoscopy aids in the diagnosis of small bowel disease.
SECONDARY BILIARY CIRRHOSIS
It is produced by obstruction of extrahepatic biliary ducts and is characterized by regeneration nodules, surrounded by fibrous septa.
Essentials of Diagnosis
- Symptoms of long-standing cholestasis either due to carcinoma head of pancreas or choledocholithiasis.
- Serum is negative for mitochondrial antibodies.
SPRUE SYNDROME (Tropical Sprue)
It is a malabsorption disease commonly found in tropics and is characterized by abnormal flattening of the villi and inflammation of the lining of the small intestine.
Essentials of Diagnosis
- Pale, bulky, greasy, frothy, foul-smelling stool with increased fecal fat on chemical analysis.
- Weight loss and multiple vitamin deficiency.
- Impaired intestinal absorption of glucose, vitamins and fat.
- X-ray shows Herringbone appearance.
- Endoscopy shows abnormal flattening of villi and inflammation of the intestinal wall.
- Biopsy shows presence of of inflammatory cells (most often lymphocytes).
- Hypochromic or megaloblastic anemia.
- Skin pigmentation.
TYPHOID FEVER
It is a type of enteric fever, a bacterial infection due to Salmonella typhi.
Essentials of Diagnosis
- Gradual onset of malaise, headache, sore throat, cough and finally ‘pea-soup’ diarrhea or constipation.
- Slow rise (step-ladder) of fever to maximum and then gradual lowering down of fever is common with maximum temperature at evening hours (variation less than 2°F). Temperature never becomes normal.
- Leukopenia, positive blood culture in first week and positive stool and urine culture.
- Positive Widal test with increasing titer.
VINCENT'S STOMATITIS
Vincent's stomatitis or trench mouth or acute necrotizing ulcerative gingivitis is a non-contagious infection of the gums with sudden onset.
Essentials of Diagnosis
- Ulcer surface covered with gray pseudomembrane surrounded by erythema.
VIRAL HEPATITIS (Infectious Hepatitis)
It is inflammation of liver caused by a viral infection. It may be acute or chronic and is caused by five unrelated hepatotropic viruses; Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D and Hepatitis E. Other viruses such as cytomegalovirus (CMV), Epstein–Barr virus and yellow fever may also affect the liver.
Essentials of Diagnosis
- Anorexia, nausea, vomiting, influenza like syndrome.
- Fever, soft enlarged tender liver, jaundice.
- Abnormal liver function tests with elevation of SGOT, serum glutamic pyruvic transaminase (SGPT) and LDH.
- Liver biopsy is characteristic.
WILSON'S DISEASE
Wilson's disease or hepatolenticular degeneration is an autosomal recessive genetic disorder characterized by accumulation of copper in tissues; this manifests as neurological or psychiatric symptoms and liver disease.57
Essentials of Diagnosis
- Symptoms of cirrhosis (jaundice, portal hypertension, splenomegaly) or chronic atypical hepatitis.
- Basal ganglion dysfunction like rigidity, Parkinsonian tremor.
- Kayser-Fleischer rings are pathognomonic (fine pigmented granular deposits in membrane of the cornea).
- Low serum ceruloplasmin (less than 20 mg), increased urinary copper excretion.
- Liver biopsy and genetic testing confirms the diagnosis.
ZOLLINGER-ELLISON SYNDROME
It is caused by a non-beta islet cell (islet of Langerhans), gastrin-secreting tumor of the pancreas that stimulates the acid-secreting cells of the stomach with consequent gastrointestinal mucosal ulceration.58
Essentials of Diagnosis
- Severe uncontrollable peptic ulcer syndrome.
- Gastric hypersecretion.
- Elevated serum gastrin more than 300 pg/mL.
- Gastrinoma of pancreas, duodenum or at other ectopic site.