Góc phần tư phía trên bên phải bụng bánh mì nhiều tập. Các yếu tố nguy cơ bao gồm tán huyết, Nữ Trước khi mang thai, béo phì, giảm cân nhanh 4, huyết khối tĩnh mạch cửa, gốc Tây Ban Nha và người Mỹ bản địa, bệnh hoặc cắt bỏ ileal, xơ nang, bệnh Wilson, dinh dưỡng và kéo dài IV | Chapter 4 Liver and Pancreas 87 Cholelithiasis Essentials of Diagnosis Episodic right upper quadrant abdominal pain. Risk factors include hemolysis females with prior pregnancy obesity rapid weight loss portal vein thrombosis Native Americans and Hispanics ileal disease or resection cystic fibrosis Wilson disease and prolonged IV nutrition Elevated bilirubin alkaline phosphatase and GGT Stones or sludge seen in gall bladder by US Pigment stones most common up to 10 years cholesterol stones most common in adolescents US is the best diagnostic test Differential Diagnosis Parenchymal liver disease Peptic disease Cardiac disease Pancreatitis Renal stones Subcapsular liver lesions abscess tumor hematoma Right lower lobe pneumonia Treatment Cholecystectomy for symptomatic patients Guidelines unclear for children with asymptomatic gall stones but surgery required in 20 of cases Ursodeoxycholate and lithotripsy not approved for this indication Pearl Gallstones are common harmless findings on prenatal ultrasound examinations. They resolve within several months of birth. 88 Current Essentials Pediatrics 4 Hepatic Cancer Essentials of Diagnosis Third most common intra-abdominal cancer of children Abdominal enlargement hepatomegaly pain weight loss anemia mass detected by abdominal computed tomography CT or US Hepatoblastoma more common in male infants and associated with Beckwith Wiedemann syndrome hemihypertrophy familial adenomatous polyposis prematurity Hepatocellular carcinoma more common after 3 years of age. Associated with chronic HBV HCV cirrhosis glycogen storage disease type I tyrosinemia a1-antitrypsin deficiency anabolic steroids US and CT examination required. Laparotomy for tissue biopsy required Differential Diagnosis Other conditions causing hepatomegaly storage disease cirrhosis vascular tumors malnutrition heart failure veno-occlusive disease hepatic vein thrombosis Infection or abscess Pancreatic tumors or cysts Inflammatory pseudotumor or mesenteric cysts
