biliary tree bits

Question 1

commonesst causative organism of ascending chollangitiss

Answer 1

E.coli !

ascending cholangitis = bacterial infection of bilary tree

common predisposing factor = gall stones

Question 2

ascending cholangitis ix

Answer 2

US
- loo for bile duct dilation + bile duct stones

Question 3

management of ascending cholangitis

Answer 3

IV ABx

ERCP after 24-48hrs to relieve any obstruction

Question 4

primary sclerosing cholangitis presentation

Answer 4

cholestasis
- jaundice, pruritis
- raised bilirubin + ALP

RUQ pain
fatigue

Question 5

primary sclerosing cholangitis investigations

Answer 5

ERCP or MRCP !!
–> multiple biliary strictures giving “beaded” appearance

Question 6

which ANCA is posiitiive in primary sclerosing cholangitis

Answer 6

p-ANCA !

Question 7

complicatiions of priimary sclerosng cholangitis

Answer 7

cholangiocarcinoma (CA19-9)

increased ris of colorectal cancer

Question 8

lymph nodes assoc with cholangiocarcinoma

Answer 8

periumbilical -> Sister Mary Joseph nodes

left supraclaviculr -> vichow

(PSC is main risc factor)

Question 9

investigations in primary biliary cholangitis (PBC)

Answer 9

AMA M2 subtyoe antibodies (in 98%)

raised serum IgM !!

US or MRCP must be done to exclude extraahepatic biliary obstruction

Question 10

management of primary biliary cholangitis

Answer 10

1st = ursodeoxycholic acid
-> slows disease, improves sx

pruritus –> cholestyramine

Question 11

PBC complcations

Answer 11

cirrhosis -> portal hypertension -> ascites, variceal haemorrhage

osteomalacia + osteoporosis

!! significantly increased ris of hepatocellular carciinoma (x20)