Biliary things

Question 1

what is primary biliary cirrhosis vs primary sclerosing cholangitis

Answer 1

PBC = intrahepatic bile ducts damaged by chronic AUTOIMMUNE inflammation causing cholestasis

PSC = destruction of intra- and extrahepatic bile ducts from fibrosis and inflammation

Question 2

antibodies in PBC

Answer 2

antimitochondrial

Question 3

symptoms

Answer 3

pt middle aged with fatigue and itching - think PBC!!!

later jaundice, xathelasmata
hepatosplenomegaly

Question 4

LFT finding PBC

Answer 4

ALK PHOS raised the most

bilirubin raised later in disease.

Liver synthetic function is preserved until late in the disease, so serum albumin and clotting are usually normal

Question 5

what may occur secondary to PBC

Answer 5

malabsorption of ADEK vitamins

osteoporsis

Question 6

treatment of PBC

Answer 6

ursodeoxycholic acid (secondary bile acid)
replace fat soluble vitamins
cholestyramine helps itch
major indication for transplant

Question 7

what may occur late in PBC

Answer 7

can lead to fibrosis, cirrhosis and portal HTN

Question 8

cause of obstruction PBC vs PSC

what is seen on microscopy?

Answer 8

pbc = granulomatous inflammation. granulomas on microscopy

PSC = fibrosis destroys bile ducts. onion skin fibrosis on microscopy

Question 9

PBC vs PSC males and females

Answer 9

PBC more common in females

PSC - males

Question 10

other disease association PBC vs PSC

Answer 10

PBC - other autoimmune disorders e.g. sjogren’s, RA etc

PSC = UC

Question 11

clinical features PBC vs PSC

Answer 11

PBC = fatigue and pruritus

PSC = progressive obstructive jaundice

Question 12

complications PBC vs PSC

Answer 12

PBC = cirrhosis

PSC = cirrhosis, cholangiocarcionoma (10% develop it)

Question 13

antibodies PBC vs PSC

Answer 13

PBC = antimitochondrial antibodies
PSC = pANCA

Question 14

what are stones made of

Answer 14

calcium bilirubinate (pigment stones, caused by excess heamolysis)
cholesterol (80% of stones)

can be mixed

Question 15

complications of stones

Answer 15

biliary colic
cholecystitis
obstructive jaundic
pancreatitis
cholangitis (inflammation of bile dut due to infection

Question 16

which duct is usually blocked in cholecystitis

Answer 16

cystic duct

Question 17

what duct is usually blocked in cholangitis

Answer 17

common bile duct

Question 18

location and radiation of pain in biliary colic

Answer 18

epigastic but may be RUQ componenet

radite over right should and right subscapular

Question 19

ix of biliary colic

Answer 19

USS

Question 20

symptoms if cholecysitis/cholangitis

Answer 20

fever

rigors

Question 21

symptoms of biliary colic

Answer 21

pain
n+v
jaundice if CBD

Question 22

difference in clinical features if cholecystits vs just a stone in the duct

Answer 22

local peritonism
fever
vomiting
raised WCC

Question 23

is there jaundice in cholecystitis

Answer 23

no as stone blocks cystic duct, not CBD

Question 24

what is murphy’s sign

Answer 24

place two fingers in RUQ and ask patient to breathe in. causes pain and ARREST of inspiration

Question 25

treatment of colic

Answer 25

pain killers

stone usually passes on its own

Question 26

how differentiate colic vs cholecystitis vs ascending cholangitis

Answer 26

colic = just pain
cholecystitis = pain + systemic symptoms
cholangitis = pain + systemic symptoms + jaundice

Question 27

organisms that cause ascending cholangitis

Answer 27

gram -ve bacilli - ecoli, enterococcus, anaerobes

Question 28

5 risk factors for cholelithiasis (stones

Answer 28

fair
fat
female
fertile
forty