hepatic and biliary disorders
Evaluation of the Patient With a Liver Disorder
History
Various symptoms may develop, but few are specific for liver disorders: Common nonspecific symptoms include fatigue, anorexia, nausea, and occasionally, vomiting, particularly in severe disorders. Loose, fatty stools (steatorrhea) can occur when cholestasis prevents sufficient bile from reaching the intestines. Patients with steatorrhea are at risk of deficiencies of fat-soluble vitamins (A, D, E, K). Common clinical consequences may include osteoporosis and bleeding. Fever can develop in viral or Alcohol-Related Liver Disease . Jaundice , occurring in both hepatocellular dysfunction and cholestatic disorders, is the most specific symptom. It is often accompanied by dark urine and light-colored stools. Right upper quadrant pain due to liver disorders usually results from distention (eg, by passive venous congestion or tumor) or inflammation of the liver capsule. Erectile dysfunction and feminization develop, usually due to imbalances in the normalestrogen/testosteroneratio, with moreestrogenbeing present than is typical. (See also Liver Structure and Function .) Family history, social history, and drug and substance use history should note risk factors for liver disorders (see table). 