Chinese Medical Information Portal Website (Taiwan Medical Network-TMN) - OldDoc Wu's Series
(Established in March 1996)
PBL for the diagnosis of Liver Disease
Dr. Wu's Liver diseases
for professionals (medical students and residents)

by Jau-Shin WU, M.D., Ph.D.
(Posted Sep. 16, 1996; Updated May 14, 2009)


PBL for the diagnosis of Liver Disease

  • What is PBL and PBeL ?
    • Traditional medical education --- Lectures in the classroom by a teacher.
    • Integration of basic and clinical medical knowledge.
    • Problem-based or Practice-based Learning (e: electronic).
    • Best method of learning medical knowledge technique and in bedside teaching.
    • Problem of the patient's physical condition (character, mechanism, etiology, diagnosis, treatment)
    • Small group teaching and an instructor.
    • Search and study of resources for solving problems from journals, references, and Internet contents by students themselves.
  • What is a liver ?
    • Liver is the largest and the most complex organ in the body, located in the right upper part of the abdomen, and it is usually not palpable from the abdominal wall.
    • Under the liver, there is a gall bladder, the liver and gallbladder are connected by ducts known as the biliary tract.
    • Refer to:
  • What is a liver disease?
  • What is the main symptoms and signs of the liver disease ?
    • Jaundice (sclera, skin).
    • Pruritus.
    • Hepatomegaly.
    • Flu-like symptoms, headache, muscle pain, fever.
    • Malaise, fatigue, weakness.
    • Nausea, vomiting.
    • Fever.
    • RUQ Pain.
    • Deep discoloration of urine.
    • Clay color stool.
    • Portal hypertension (splenomegaly, esophageal varices, ascites, edema of the lower legs)
    • Spider angiomata (nevi), palmer erythema, engorgement of superficial veins of the abdomen and thorax, gynecomastia.
    • Bleeding tendency (Purpura: ecchymosis, petechiae, suggilation)
    • Hemopoiesis: anemia, leukopenia, throbocytopenia
    • Encephalopathy (drowsiness, tremor, asterixis, dysarthrias, delirium, coma)
    • No any symptoms and signs.
    • Refer to:
  • Laboratory data of liver diseases
  • Image diagnosis of liver diseases
    • Simple X-ray film
    • Ultrasonography
    • Endoscopic ultrasonography
    • CT
    • Angiography
    • MRI
  • How to proceed the diagnosis of liver diseases
    • SOAP (Subjective, Objective, Analysis, Planning)
    • PBL (Problem based learning), PBeL (Problem based e-learning)
  • Neighboring organs of the liver
    • Lung, diaphragm, gall bladder, bile duct, duodenum, stomach, pancreas and transverse colon.
    • Pain and tumor.

Practical application

  • SOAP = PBL
  • Basic data:
    • Name, age, sex
    • Residence history:
      • past, present, and duration.
      • Travelling.
      • What is the endemic diseases of the indwelling or travel place. (i.e: HAV, HEV, Dengue fever, Schistosomiasis)
  • Past history: (alcoholics, drug intake, IVDA, infection)

Case 1:Da-Ming Yang. 72 yrs old, male