Hepatology is an important specialty with diseases and complications related to viral hepatitis and alcohol being the main reason for seeking specialist advice. On most general medical rotations and on most surgical wards there are patients with hepatological problems. Hepatology: Clinical Cases Uncovered contains clinical presentations with real-life patient cases and outcomes as seen on the wards and in exams, and leads students through a practical approach to diagnosis and management of hepatological disease.

Following a question and answer approach, including self-assessment material and a ‘refresher’ section on the basic science, Hepatology: Clinical Cases Uncovered features investigations and the treatment options available for patients presenting with hepatological problems. Difficult concepts are clarified and relevant links are made between pathology and clinical presentation.

Preface, vii
Acknowledgements, viii
How to use this book, ix
Normal values, x
List of abbreviations, xi

Part 1 Basics, 1

Basic science, 1
Approach to the patient, 20

Part 2 Cases, 39

Patients with acute liver disease

Case 1 A 19-year-old man presenting with jaundice, 39
Case 2 A 25-year-old man with nausea, vomiting and jaundice, 42
Case 3 A 45-year-old woman presenting with severe right upper quadrant pain and jaundice, 46
Case 4 A 72-year-old man with painless jaundice, 52
Case 5 A 23-year-old woman with vomiting and epigastric pain, 57
Case 6 A 4-week-old baby with jaundice and failure to thrive, 63
Case 7 A 24-year-old woman with HIV and tuberculosis develops jaundice, 68
Case 8 Abnormal liver function tests in a collapsed patient, 71
Case 9 Abnormal liver function tests in a pregnant woman, 74
Case 10 A 27-year-old woman with abdominal pain and distension, 77

Patients with chronic liver disease

Case 11 A 40-year-old woman with lethargy and pruritus, 81
Case 12 A 25-year-old woman with malaise and elevated liver enzymes, 87
Case 13 Deranged liver function tests in a patient with ulcerative colitis, 90
Case 14 Fatigue and deranged liver function tests in a patient with haemophilia, 94
Case 15 A 34-year-old man from Hong Kong with jaundice and vomiting, 99
Case 16 Acute deterioration in a 21-year-old man with chronic hepatitis B virus infection, 106
Case 17 A 53-year-old man with a history of high alcohol intake, 108
Case 18 A 57-year-old man with diabetes and elevated alanine aminotransferase, 114
Case 19 A 42-year-old man with shortness of breath and abnormal liver function tests, 120
Case 20 A 58-year-old man with diabetes and abnormal liver function tests, 123
Case 21 A 16-year-old boy with cognitive deterioration, ataxia and abnormal liver function tests, 126

Patients with deterioration in chronic liver disease

Case 22 A 43-year-old man with a large gastrointestinal bleed, 129
Case 23 A 58-year-old woman with a distended abdomen, 138
Case 24 A 67-year-old man with cirrhosis and confusion, 142
Case 25 A 47-year-old woman suddenly presents with variceal haemorrhage, 146

Patients with abnormal radiological imaging

Case 26 A 37-year-old woman with abnormal liver ultrasound, 150
Case 27 A 72-year-old man with right upper quadrant pain and fever, 155
Case 28 A 52-year-old man with diarrhoea and a liver mass, 159
Case 29 A 69-year-old man with a liver mass, 161
Liver transplantation
Case 30 A 56-year-old man with abnormal liver function tests 4 weeks after liver transplantation, 164

Part 3 Self-assessment, 167

MCQs, 167
EMQs, 174
SAQs, 179
Answers, 181
Index of cases by diagnosis, 195
Index, 197