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Gastrointestinal > Biliary Pathology > Flashcards

Biliary Pathology Flashcards

(50 cards)

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1
Q

What is primary biliary cholangitis?

A

Autoimmune inflammation and destruction of bile ducts, causing the build up of bile and other toxins in the liver

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2
Q

What sex is primary biliary cholangitis more common in?

A

F>M

90% of patients are female

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3
Q

What age is primary biliary cholangitis more likely to occur?

A

Middle aged

30-60

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4
Q

What conditions are associated with primary biliary cholangitis?

A

RA

Coeliac

Sjogren’s syndrome

Hypothyroidism

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5
Q

How does primary biliary cholangitis present?

A

Pruritis

Jaundice

Fatigue

Pale stools and dark urine

Xanthelasmata and xanthoma

Hepatomegaly and splenomegaly

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6
Q

What investigations are used in primary biliary cholangitis diagnosis?

A

Antimitochondrial auto-antibodies (AMA)

LFT

  • Increased ALP
  • Increased GGT
  • Increased bilirubin

IgM elevation

>ESR

Liver biopsy, for diagnosis

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7
Q

In what percentage of primary biliary cholangitis patients are AMA antibodies present?

A

+ in over 95%

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8
Q

How is primary biliary cholangitis managed?

A

Ursodeoxycholic Acid (UDCA)

  • Bile acid analogue

Cholestyramine

  • For pruritis

Steroids/immunosuppression is sometimes considered

Liver transplant if end stage liver disease

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9
Q

Give complications of primary biliary cholangitis

A

Liver cirrhosis

Osteoporosis

Hypothyroidism

Hepatocellular carcinoma

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10
Q

What is primary sclerosing cholangitis?

A

Chronic progressive inflammation and fibrosis of the intra and extrahepatic bile ducts, preventing bile draining from the liver/cholestasis

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11
Q

What sex is primary sclerosing cholangitis more common in?

A

M>F

70% of patients are men

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12
Q

What age is biliary sclerosing cholangitis more common in?

A

Middle age

3rd-5th decade

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13
Q

What conditions are associated with primary sclerosing cholangitis?

A

UC, 80% of patients with PSC have UC

Cholangiocarcinoma

HIV

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14
Q

How does primary sclerosing cholangitis present?

A

Pruritis

Fatigue

Weight loss

RUQ pain

Night sweats

Pyrexia

Hepatomegaly

Obstructive jaundice

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15
Q

What investigations are used in primary sclerosing cholangitis diagnosis?

A

MRCP/ERCP

  • Beaded appearance of ducts

LFTs

  • Increased ALP, most deranged
  • Increased bilirubin

pANCA+

Increased IgM

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16
Q

How is primary sclerosing cholangitis managed?

A

UDCA

ERCP and biliary stents

Liver transplant

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17
Q

Give complications of primary sclerosing cholangitis?

A

Cholangiocarcinoma

Liver cirrhosis

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18
Q

What are the types of gallstones?

A

Cholesterol

Bilirubin/pigmented

Mixed

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19
Q

What is the most common type of gallstone?

A

Mixed (80%)

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20
Q

What are the causes of gallstones?

A

4 F’s

  • Female
  • Fat
  • Forty
  • Fair

Associated conditions

  • Diabetes
  • Pigment conditions/sickle cell anaemia/liver cirrhosis
  • Chrons

Drugs

  • COCP
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21
Q

How does gallstones/biliary colic present?

Study These Flashcards
A

Majority asymptomatic, symptoms occur due to biliary colic

Sudden severe epigastric/RUQ pain

  • Often triggered by meals
  • Radiates to interscapular region

N&V

Jaundice

22
Q

What investigations are used in gallstone diagnosis?

Study These Flashcards
A

EUS, best initial investigation

LFTs

  • Increased ALP

MRCP

Amylase, to rule out pancreatitis

23
Q

What is first line investigation/most useful investigation in gall stones?

24
Q

How are gallstones managed?

Study These Flashcards
A

For asymptomatic, do nothing

Dissolution, given for frail patients unsuitable for surgery

Cholecystostomy/implanting drain to drain gallbladder

Laparoscopoc cholecystectomy

25
Name complications of gallstones
Acute pancreatitis Ascending cholangitis Cholecystitis Ileus/small bowel obstruction Obstructive jaundice Biliary colic, in which stone blocks gallbladder Mirrizi's Syndrome
26
Give side effects of ERCP/MCRP
Haemorrhage Duodenal perforation Cholangitis Pancreatitis
27
When is ERCP done over MRCP?
Only used if patient is unable to tolerate MRCP (ie metal implants), as ERCP is more invasive
28
Give complications of cholecystectomy
Bleeding, infection, pain and scars Damage to the bile duct including leakage and strictures Stones left in the bile duct Damage bowel, blood vessels or other organs Anaesthetic risks DVT or PE Post-cholecystectomy syndrome
29
What is Mirrizi's Syndrome?
Gallstone in cystic duct or neck of gallbladder, leading to obstruction of common hepatic duct
30
What is cholestasis?
Accumulation of bile within the hepatocytes due to blockage of flow
31
What causes cholestasis?
Viral hepatitis Alcoholic hepatitis Liver failure Drugs Obstetric cholestasis
32
What is cholecystitis?
Inflammation of the gallbladder, usually due to gallstone causing obstruction of gall bladder outlet (think gallstones/biliary colic, but systemically unwell)
33
How does cholecystitis present?
Sudden sharp pain in right upper quadrant * Radiating to right shoulder * Pain worse when breathing deeply * Persistent pain N&V Sweating Murphy's Sign Systemic upset * Pyrexia * Tachycardia * Tachypnoea
34
What is Murphy's sign?
Patient catches breath on inspiration when two fingers are placed in RUQ, yet not in the LUQ
35
What investigations are used in cholecystitis diagnosis?
FBC * \>WCC LFTs are often normal US, to assess gallstones
36
How is cholecystitis managed?
Supportive * Analgesia * IV fluids IV antibiotics * Cefuroxime and Metronidazole Laparoscopic cholecystectomy * Within 1 week of diagnosis
37
What is ascending cholangitis?
Infection of the biliary tree due to lesion/gall stone in the common bile duct which results in bacteria ascending from the duodenum
38
What organism is associated with ascending cholangitis?
E coli
39
How does ascending cholangitis present?
RUQ pain Fever Jaundice Dark urine Pale stools Pruritis Tachycardia Hypotension Confusion
40
What is Charcot's triad?
**Associatd with ascending cholangitis** Jaundice Fever RUQ pain
41
What is Reynolds pentad?
**Associated with ascending cholangitis** Jaundice RUQ pain Fever Shock/hypotension Altered mental status
42
What investigations are used in ascending cholangitis diagnosis?
FBC * \>WCC \>CRP LFTs * \>ALP * \>Bilirubin ERCP US
43
How is ascending cholangitis managed?
Supportive * IV fluids * Analgesia * IV Antibiotics (Cefuroxime and Metronidazole) Endoscopic/ERCP * After 24-48 hours to relieve obstruction * Stone removal * Stent placement Cholecystectomy
44
How do you differentiate between biliary colic, cholangitis and cholecystitis?
Biliary colic patient is usually systemically well and pain is chronic and intermittent/occurs after eating Cholangitis patient will be systemically unwell and jaundiced, think charcot's triad Cholecystitis patient is systemically unwell, think charcot's triad but murphy's sign instead of jaundice
45
What is cholangiocarcinoma?
Malignancy of the biliary tree
46
What is the most common type of choliangocarcinoma?
Adenocarcinoma
47
Give risk factors for cholangiocarcinoma
Primary sclerosing cholangitis, and hence IBD Gallstones/history of gallstone disease Porcelain/calcification of gallbladder due to cholecystitis Gallbladder adenoma/polyps Abnormal bile duct anatomy Obesity Infection causing chronic cholangitis Smoking
48
How does cholangiocarcinoma present?
Pruritis Jaundice Weight loss Palpable gall bladder/Courvoisier sign Hepatomegaly Lymphadenopathy * Sister Mary Joseph node * Virchow's node Intermittent RUQ pain, associated with eating fatty foods
49
How is cholangiocarcinoma managed?
Surgery, only 10% are suitable for curative resection Stenting Chemo/radiotherapy
50
Give complications of laparoscopy
General risks of anaesthetic Vasovagal reaction (e.g. bradycardia) in response to abdominal distension Extra-peritoneal gas insufflation/surgical emphysema Injury to gastro-intestinal tract Injury to blood vessels e.g. common iliacs, deep inferior epigastric artery

Gastrointestinal (14 decks)

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