Biliary Disease Flashcards
(33 cards)
What is primary biliary cholangitis?
A chronic liver disorder typically seen in middle-aged females, previously referred to as primary biliary cirrhosis.
What is the female to male ratio for primary biliary cholangitis?
9:1
What is the suspected aetiology of primary biliary cholangitis?
An autoimmune condition
What happens to the interlobular bile ducts in primary biliary cholangitis?
They become damaged by a chronic inflammatory process.
What is a classic presentation of primary biliary cholangitis?
Itching in a middle-aged woman
Which syndrome is associated with up to 80% of patients with primary biliary cholangitis?
Sjogren’s syndrome
List other associations of primary biliary cholangitis.
- Rheumatoid arthritis
- Systemic sclerosis
- Thyroid disease
What are early clinical features of primary biliary cholangitis?
- May be asymptomatic
- Fatigue
- Pruritus
What are late clinical features of primary biliary cholangitis?
May progress to liver failure
What is the significance of anti-mitochondrial antibodies (AMA) in primary biliary cholangitis?
Present in 98% of patients and are highly specific.
What imaging is required before diagnosing primary biliary cholangitis?
Right upper quadrant ultrasound or MRCP to exclude extrahepatic biliary obstruction.
What is the first-line management for primary biliary cholangitis?
Ursodeoxycholic acid
What is used to manage pruritus in primary biliary cholangitis?
Cholestyramine
What is a major indication for liver transplantation in primary biliary cholangitis?
If bilirubin > 100
What are some complications of primary biliary cholangitis?
- Cirrhosis
- Portal hypertension
- Osteomalacia
- Osteoporosis
- Increased risk of hepatocellular carcinoma
What is primary sclerosing cholangitis?
A biliary disease of unknown aetiology characterised by inflammation and fibrosis of intra and extra-hepatic bile ducts.
What is the association between ulcerative colitis and primary sclerosing cholangitis?
4% of patients with UC have PSC, 80% of patients with PSC have UC.
What are common features of primary sclerosing cholangitis?
- Cholestasis
- Jaundice
- Pruritus
- Raised bilirubin + ALP
- Right upper quadrant pain
- Fatigue
What diagnostic investigations are standard for primary sclerosing cholangitis?
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Magnetic resonance cholangiopancreatography (MRCP)
What is a marker of primary sclerosing cholangitis?
P- ANCA may be positive in patients.
What complications are associated with primary sclerosing cholangitis?
- Cholangiocarcinoma (in 10%)
- Increased risk of colorectal cancer
What are the adverse effects of chlestyramine?
Adverse effects
abdominal cramps and constipation
decreases absorption of fat-soluble vitamins
cholesterol gallstones
may raise level of triglycerides
What is the cause of colicky abdominal pain, worse postprandially, worse after fatty foods?
Biliary colic
What is the cause of Right upper quadrant pain
Fever
Murphys sign on examination?
Acute cholecystitis
-> Murphy’s sign is inhalation due to pain in RUQ on palpation
