Haemobilia

Question 1

Haemobilia

Answer 1

Haemobilia

A condition in which there is bleeding into the biliary tree following connection between splanchnic circulation and either the intrahepatic or extrahepatic biliary system. Characterized by right upper quadrant pain, evidence of upper GI bleeding and jaundice.

Question 2

Haemobilia post Liver Biopsy

Answer 2

A 54-year-old gentleman is reviewed on the ward two hours following a liver biopsy. He was admitted three days ago with jaundice and diagnosed with acute hepatitis. He has a background of hypertension, anxiety and cholecystectomy. He has minimal alcohol intake and an acute liver screen has found no obvious cause for his hepatitis and therefore he underwent the biopsy. On review, the patient is complaining of severe right upper quadrant pain and feeling generally unwell. The nurse has noted dark stool which he thinks is consistent with melaena. On examination his blood pressure is 94/56 mmHg, heart rate is 113/min, oxygenation is 94% and respiratory rate is 26/min. On examination he is jaundiced, has a tender right upper quadrant and a PR examination reveals melaena. What is the most likely cause of his deterioration?

	Duodenal rupture
	> Haemobilia
	Pneumothorax
	Variceal bleed
	Peptic ulcer

The correct answer is haemobilia. This is a patient who develops right upper quadrant pain and melaena following liver biopsy. The most likely explanation is that the biopsy needle has hit the splanchnic vein and this has resulted in bleeding into the biliary tree.