<prompt> Answer this question truthfullyWhat are the possible alternative diagnoses for hepatocellular carcinoma?  <response>: <reason> Hepatocellular carcinoma must be differentiated from the following diseases: Angiomyolipoma Adenoma Borderline high-grade dysplastic nodule Cholangiocarcinoma Confluent fibrosis Focal nodular hyperplasia Focal fat sparing and deposit on liver cite_note-NicolauBr2004-23 Gallbladder cancer Hereditary hemorrhagic telangiectasia Inflammatory pseudotumors Liver hemangioma Hepatoblastoma in children Inflammatory lesions Mesenchymal hamartoma in children Multiacinar regenerative nodule Macroregenerative nodule low-grade dysplastic nodule Nontumorous arterioportal shunts Pseudomass in chronic portal vein thrombosis Pyogenic liver abscesses Pancreatic cancer Stomach cancerAbbreviations: RUQ Right upper quadrant of the abdomen, LUQ Left upper quadrant, LLQ Left lower quadrant, RLQ Right lower quadrant, LFT Liver function test, SIRS Systemic inflammatory response syndrome, ERCP Endoscopic retrograde cholangiopancreatography, IV Intravenous, N Normal, AMA Anti mitochondrial antibodies, LDH Lactate dehydrogenase, GI Gastrointestinal, CXR Chest X ray, IgA Immunoglobulin A, IgG Immunoglobulin G, IgM Immunoglobulin M, CT Computed tomography, PMN Polymorphonuclear cells, ESR Erythrocyte sedimentation rate, CRP C-reactive protein, TS Transferrin saturation, SF Serum Ferritin, SMA Superior mesenteric artery, SMV Superior mesenteric vein, ECG ElectrocardiogramDisease Clinical manifestations Diagnosis Comments Symptoms Signs Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo- tension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Hepatocellular carcinoma Metastasis RUQ Normal Hyperactive if obstruction present High levels of AFP in serum Abnormal liver function tests Thrombocytopenia US CT MRI Liver biopsy Other symptoms: Splenomegaly Variceal bleeding Ascites Spider nevi Asterixis Cholangiocarcinoma RUQ Normal Elevated CA 19-9 Increased amylase lipase Increased stool fat content Contrast-enhanced ultrasound CT scan Calcification Pseudocyst Dilation of main pancreatic duct MRI Predisposes to pancreatic cancer Pancreatic carcinoma Mid Epigastric Normal Alkaline phosphatase serum bilirubin gamma-glutamyl transpeptidase CA 19-9 MDCT with PET CT MRI EUS Skin manifestations may include: Bullous pemphigoid Cicatricial pemphigoid Migratory superficial thrombophlebitis classic Trousseaus syndrome Pancreatic panniculitis Focal nodular hyperplasia Diffuse Normal Normal Liver function tests Normal AFP Minor elevations of Aspartate Alanine aminotransferase Alkaline phosphatase Gamma glutamyl transpeptidase Us Multiphasic helical CT scan Open biopsy if diagnosis can not be established Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo- tension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments Gallbladder cancer Mid epigastric Normal Alkaline phosphatase CA 19-9 US CT MRI Liver hemangioma Intermittent RUQ Normal Abnormal LFTs US Single-photon emission computerized tomographySPECT MRI US will reveal hypoechoic lesions Liver abscess RUQ Normal Hypoalbuminemia Abnormal liver function tests US CT Cirrhosis RUQ Bloating Normal Hypoalbuminemia Prolonged PT Abnormal LFTs Hyponatremia Thrombocytopenia US Nodular, shrunken liver Ascites Stigmata of liver disease Cruveilhier- Baumgarten murmur Inflammatory lesions RUQ Normal Hypoalbuminemia Prolonged PT Abnormal LFTs Hyponatremia Thrombocytopenia US Nodular,shrunken or coarse liver Stigmata of liver diseaseTemplate:WikiDoc Sources 