Acute Liver Capsule Pain Management — SCE Palliative Medicine MCQ

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ModerateGI SymptomsAcute Liver Capsule Pain ManagementSCE Palliative Medicine

A 75‑year‑old woman with advanced bowel cancer develops acute right upper quadrant pain with rapid onset of hepatic distension. CT confirms rapid progression of liver metastases causing hepatic capsular stretch. She is in significant distress. What is the most appropriate initial analgesic approach?

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Correct answer: D — Dexamethasone with appropriate opioid escalation

Option D is correct. In UK palliative care practice, dexamethasone is the adjuvant of choice for acute liver capsular pain due to inflammatory oedema and mechanical stretch. Scottish guidelines recommend 4‑8 mg daily, and NHS England palliative care summaries endorse 8‑16 mg for cancer‑related capsular pain. An immediate IV dose ensures rapid action; opioids manage breakthrough pain while the steroid works. Option C (NSAID alone) lacks sufficient anti‑inflammatory potency and poses GI/renal risks; B (paracetamol only) fails to target the pathophysiology; C (gabapentin) treats neuropathic pain, not capsular stretch; E (biopsy) is unnecessary and delays analgesia. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: Scottish Palliative Care Guidelines – Pain Management – Dexamethasone for liver capsule pain; Palliative Care Clinical Practice Summary (2025) – Dexamethasone for cancer‑related pain: https://bnf.nice.org.uk/