80. Biliary tract

Question 1

Most common hepatitis

Answer 1

A, B, C

Question 2

RF for hep A

Answer 2

o	Fecal oral
o	Blood is rare
o	Many cases asymptomatic
o	Vaccines for
	MSM
	IVDU
	Drug users
o	30 day incubation

Question 3

RF for hep B

Answer 3

o Secreted into serum of infected person
o Highest rates in MSM and IVDU
o Salive, semen, stool, tears, urine, vaginal
o 10% of adults become chronic carriers

Question 4

RF for hep C

Answer 4

o Used to be blood transfusions
o Now IVDU and > 20 sex partners
o Short acute phase, then chronic phase

Question 5

Read indications for HbIG and vaccine

Answer 5

In chapter

Question 6

Lab findings in alcholic hepatitis

Answer 6

• Moderate AST/ALT rise, but over 10x unusual
• Bili is usually elevated
• WBC 10-20
• INR gives idea of dysfunction

Question 7

MGMT of EtOH hepatitis

Answer 7

• IVF and lyte mgmt.
• Antiemetics
• May have hypoglycemia, and need glucose
  o Give thiamine
• Give Mg unless contraindicated

Question 8

MGMT of variceal bleed

Answer 8

o	Octreotide
o	Vasopressin
o	Balloon tamponade
o	Possible TIPS procedure later
- PLTs if <50
- possible vit K

Question 9

Labs in cirrhosis

Answer 9

• AST/ALT rarely more than minimal increase
• Bili often not high until very advanced
• ALP out of proportion suggests
• Coag changes

Question 10

Meds for SBP

Answer 10

ceftriaxone

albumin 1g/kg

Question 11

Possible causes of hepatic encephalopathy

Answer 11

GI bleed
Lyte abnormalities
VTE
Ileus and constipation
sedative meds
dehydrations
AKI
infection

Question 12

MGMT of hepatic encephlopathy

Answer 12

• Control airway PRN
• Address lytes and GI bleeding
• Stop all CNS depressants
• Lactulose 30-60 until poo
• Oral aminoglycocide with flagyl may help reduce ammonia procuding bacteria in gut

Question 13

Indication to start ABx in SBP

Answer 13

WBC > 250 in tap

Question 14

Presentation of pyogenic abscess

Answer 14

• RUQ pain, fever, N/V
• Ill appearing
• Acute

Question 15

Labs of pyogenic abscess

Answer 15

• ALP and bili elevated
• Leukocytosis
• AST/ALT 2-4x normal

Question 16

MGMT of pyogenic abscess

Answer 16

• Ceftri and flagyl
• Possible add vanco
• > 3cm requires drainage

Question 17

presentation of amebic abscess

Answer 17

• Acute
• Fever, NV and abdo pain
• Diarrhea common in children

Question 18

MGMT of amebic abscess

Answer 18

• Flagyl 750 TID for 7-10 days

- Drain only for refractory cases

Question 19

Presentation of cholestatis of preg

Answer 19

• In third trimester
• Progressive pruritus
• Bili may have mild elevation

Question 20

What is budd-chiari

Answer 20

• Hepatic venous outflow obstruction above the hepatic venules
• Associated with hypercoagulable states
• Can cause acute obstructive states and acute livers failure
• Newly Dx may need TIPS procedure

Question 21

2 types of gall stones

Answer 21

Cholesterol
 Usually due to elevated levels in bile acids
	RF
•	Age
•	Female
•	obesity
Pigmented
•	usually due to infections

Question 22

MGMT of cholecystitis

Answer 22

• Fluids and pain control
• Usually start on tazo
  o Until surgery

Question 23

US findings of cholecytitis

Answer 23

o Stones, thickened wall, pericholecystic fluid

Question 24

Patho of cholangitis

Answer 24

• Acute obstruction usually due to stone, but also tumor or stricture
• Also have elevated luminal pressure and infection
• Retrograde infection

Question 25

Triad of cholangitis

Answer 25

Fever
RUQ
jaundice

Question 26

Pentad of cholangitis

Answer 26

Fever
RUQ 
jaundice
AMS
Hypotension

Question 27

MGMT of cholangitis

Answer 27

Fluids
Pressors PRN
Tazo