Pancreatic Disorders
A 46-year-old man presents with severe epigastric pain radiating to his back after a weekend of heavy alcohol consumption. He has nausea and vomiting, and serum lipase is markedly elevated.
Acute Pancreatitis
A 42-year-old woman develops episodic RUQ pain after eating fatty meals. The pain resolves after several hours. She is afebrile, and ultrasound demonstrates gallstones without gallbladder inflammation.
Biliary Colic
A 23-year-old college student develops fatigue, anorexia, jaundice, and RUQ discomfort after returning from a trip where he consumed contaminated food. AST and ALT are markedly elevated.
Acute Hepatitis A
A 35-year-old woman presents with jaundice, fatigue, and RUQ discomfort. She recently started a new medication. AST and ALT are >1,000 U/L, while alkaline phosphatase is only mildly elevated.
A healthy 20-year-old develops mild jaundice during periods of fasting and stress. Laboratory studies demonstrate isolated unconjugated hyperbilirubinemia with otherwise normal liver tests.
Gilbert syndrome
A 54-year-old man with years of heavy alcohol use has recurrent epigastric pain, weight loss, and greasy, foul-smelling stools. Abdominal imaging demonstrates pancreatic calcifications.
Chronic Pancreatitis
A 47-year-old woman develops persistent RUQ pain, fever, nausea, and vomiting after eating. Examination demonstrates a positive Murphy sign.
Acute Cholecystitis
A 48-year-old man with longstanding heavy alcohol use presents with jaundice, fever, and tender hepatomegaly. AST is 220 U/L and ALT is 90 U/L.
Alcohol-associated hepatitis
A 56-year-old man with cirrhosis develops increasing abdominal distention, fever, and diffuse abdominal pain. Paracentesis reveals an ascitic neutrophil count of 400 cells/mm³.
Spontaneous bacterial peritonitis
A patient develops jaundice, fatigue, and dark stools. Hemoglobin is decreased, LDH and reticulocytes are elevated, haptoglobin is decreased, and unconjugated bilirubin is elevated.
Hemolytic Anemia
A 50-year-old woman presents several weeks after an episode of acute pancreatitis with persistent abdominal discomfort and early satiety. CT reveals a well-circumscribed fluid collection adjacent to the pancreas without an epithelial lining.
Pancreatic Pseudocyst
A 59-year-old man presents with jaundice and RUQ discomfort. Laboratory testing shows predominantly direct hyperbilirubinemia and elevated alkaline phosphatase. Ultrasound demonstrates a dilated common bile duct containing a stone.
Choledocholithiasis
A 38-year-old woman presents with fatigue and jaundice. AST and ALT are markedly elevated. Testing demonstrates positive ANA and anti-smooth muscle antibodies with elevated serum IgG.
Autoimmune hepatitis
A 58-year-old man with cirrhosis suddenly develops confusion, personality changes, and a flapping tremor when his arms are extended. His symptoms began after an upper GI bleed.
Hepatic encephalopathy
A newborn develops severe unconjugated hyperbilirubinemia shortly after birth. Testing reveals complete absence of UDP-glucuronosyltransferase activity, and the infant develops neurologic abnormalities from bilirubin deposition.
Crigler-Najjar syndrome
A 68-year-old man presents with progressive painless jaundice, weight loss, dark urine, and pale stools. Examination reveals a palpable, nontender gallbladder.
Pancreatic adenocarcinoma
A 72-year-old woman presents with fever, RUQ pain, and jaundice. She becomes hypotensive and confused several hours later.
Acute ascending cholangitis
A 22-year-old develops personality changes, tremor, jaundice, and elevated aminotransferases. Examination demonstrates brown rings surrounding the corneas.
Wilson disease
A 32-year-old woman develops abdominal pain, ascites, and hepatomegaly several months after starting estrogen-containing oral contraceptives. Doppler ultrasound demonstrates thrombosis of the hepatic veins.
Budd-Chiari
A 25-year-old has lifelong mild conjugated hyperbilirubinemia but is otherwise healthy. Liver biopsy demonstrates characteristic darkly pigmented hepatocytes.
Dubin-Johnson syndrome
A 68-year-old man has recurrent pancreatitis. MRI demonstrates dilation of the main pancreatic duct with multiple mucin-producing cystic lesions that communicate with the pancreatic duct.
Intraductal papillary mucinous neoplasm
A 66-year-old man presents with progressive painless jaundice, pruritus, weight loss, pale stools, and dark urine. Imaging demonstrates intrahepatic biliary dilation with a mass at the hepatic duct bifurcation.
Hilar Cholangiocarcinoma (Klatskin tumor)
A 53-year-old man develops fatigue, diabetes mellitus, hyperpigmented skin, arthralgias, and hepatomegaly. Laboratory studies demonstrate increased ferritin and transferrin saturation.
Hereditary hemochromatosis
A 64-year-old man with cirrhosis and chronic hepatitis develops weight loss and RUQ pain. Surveillance ultrasound reveals a new liver mass, and imaging demonstrates arterial enhancement with venous washout.
Hepatocellular carcinoma
A 30-year-old woman develops jaundice, nausea, and RUQ pain. LMP was 14 weeks ago. Laboratory testing shows elevated conjugated bilirubin and bile acids with a predominantly cholestatic pattern. Her symptoms resolve after delivery.
Intrahepatic cholestasis of pregnancy