Gastroenterology Flashcards
(171 cards)
1
Q
Main differentials for a GI bleed
A
Oesophagitis Peptic ulcer Varices/Portal hypertensive gastropathy Erosive duodenitis or gastritis Mallory-Weiss tear Malignancy Vascular malformations
2
Q
Two commonly used scoring system for GI bleed
A
Rockall or Glasgow Blatchford
3
Q
When should you give a patient blood?
A
Hg <70g/L (or has significant CVD)
4
Q
Secondary prevention of varices?
A
Beta blockers
5
Q
What is the post-endoscopy care for a patient with gastric bleeding?
A
PPI (omeprazole/lansoprazole)
H.pylori treatment
Re-endoscopy in 6-8 weeks as risk of rebleeding
6
Q
When would you give IV PPI for a gastric bleed, and how long for?
A
If visible blood vessel or actively bleeding ulcer at time of endoscopy
72 hours of IV PPI
7
Q
Immediate treatment of variceal bleed? When is it contraindicated?
A
2mg qds Terlipressin (vasoconstrictor)
+ IV abx if also liver disease (risk of bacteria from gut entering blood stream)
CI in peripheral vascular disease
8
Q
Main causes of liver disease
A
Alcohol
NAFLD (insulin resistance leading to fat accumulation)
Viral hepatitis (A to E, EBV, CMV)
Drugs (paracetamol, idiosynchratic)
Immune (autoimmune hepatitis, primary biliary cholangitis/cirrhosis, sclerosing cholangitis)
Inherited (haemochromatosis, Wilson’s, alpha1 antitrypsin deficiency)
Vascular (Budd-Chiari, liver ischaemia)
9
Q
Liver non-invasive screen
A
SCREENING QUESTIONS
Bloods:
LFTs, FBC, U&Es
Haematology:
Iron studies
Viral serology:
hep B surface antigen, hep C antibody, HIV
Immunology:
autoantibodies, Anti-mitochondrial, anti-nuclear, smooth muscle, Ig, COELIAC
Biochemistry:
iron studies, ferritin, copper studies, alpha1 antitrypsin, blood glucose
Young patients:
serum copper, caeruloplasmin
Imaging (US, CT/MRI, endoscopy)
10
Q
Score to use to determine who should get liver transplant?
A
MELD score
11
Q
What approach would you take in a patient with jaundice?
A
?Large duct obstruction (need imaging; hx of rigors or biliary pain)
?Severe liver injury (ill patient, high transaminases, coagulopathy, encephalopathy)
?Potential drug cause
?Another obvious cause (alcohol, viral hep, pregnancy, heart failure, cancer)
Fast-track non-invasive screen (hepatitis, CMV, EBV, auto-antibodies, Ig)
Liver biopsy
12
Q
Ascites management
A
Fluid and salt restriction
Diuretics (SPIRONOLACTONE, furosemide as adjuvant, monitor weight)
Large-volume paracentesis
Transjugular intrahepatic porto-systemic shunt (TIPSS) - risk of encephalopathy (not possible if MELD >18, HF, pulmonary HTN)
13
Q
Common changes in electrolytes in liver disease?
A
Hypo everything
14
Q
What is iron deficiency anaemia a high risk sign of?
A
GI malignancy
Renal cancer
Therefore require both bi-directional endoscopy and urine dipstick/USS renal
15
Q
First test to be done if iron deficiency anaemia?
A
Coeliac screen (tTg antibody)
16
Q
What does a sigmoidoscopy look at?
A
Left side of large intestine (descending colon, sigmoid and rectum)
17
Q
What are the possible tests to assess the colon?
A
Colonoscopy/flexible sigmoidoscopy
Virtual colonoscopy (CT pneumocolon) - radiation risk, may miss early cancers
CT with long oral prep (good for old and frail but can miss smaller cancers)
Colon capsule (research tool)
18
Q
Definition of diarrhoea
A
Passage of 3 or more loose stools in 24 hours
19
Q
Definition of dysentery
A
Presence of blood/mucus in stools
20
Q
What are the four mechanisms of diarrhoea and examples of each
A
Osmotic (lactose intolerance, osmotic laxatives e.g. lactulose)
Malabsorption (pancreatic insufficiency, Crohn’s, Coeliac)
Motility (post vagotomy, IBS, carcinoid)
Secretory
21
Q
Blood tests to investigate diarrhoea
A
FBC, CRP, thyroid function, coeliac serology
22
Q
Investigations for acute presentation of suspected IBD
A
Bloods: FBC, CRP, U&Es, LFT
Stool culture and microscopy
Barium x-ray
Flexible sigmoidoscopy (colonoscopy dangerous to do if acute flare)
23
Q
Treatment for severe first presentation of UC
A
ANTICOAGULATION (risk of DVT)
IV steroids (hydrocortisone or methylprednisolone)
Assess at day 3 (stool sample, CRP, albumin)
Continue if responding
IV infliximab or cyclosporine if no response
Surgery if no response
24
Q
Coeliac testing
A
TTG antibodies and IgG (some patients are IgA deficient, and TTG ab is a type of IgA)
OGD and duodenal biopsy (villous atrophy)
25
Causes of lower GI bleeding (categorised)
Anatomical: diverticular disease (most common), haemorrhoids, anal fissures
Vascular: angiodysplasia; acute mesenteric ischaemia (ischaemic colitis)
Neoplasmic: polyps, colorectal carcinoma
Inflammatory: IBD, infective
26
Most common area for diverticuli
sigmoid
27
Diverticular disease diagnosis
Colonoscopy
CT cologram
Abdo CT with contrast (identify inflammation and abscesses)
Barium enema
28
Diverticular disease treatment
Increased dietary fibre intake
Mild attacks of diverticulitis with abx
Hinchey IV with faecal peritonitis will require surgical resection and stoma
29
Angiodysplasia pathophysiology and presentation
AVM usually in proximal colon
Episodic painless bleeding and usually self-limiting
30
What is Heyde's syndrome
Angiodysplasia associated with aortic stenosis
31
Acute mesenteric ischaemia presentation
Severe pain out of proportion of clinical signs
Bleeding less common
Associated with AF --> emboli has migrated to bowel
32
Genetic conditions causing polyps
Familial adenomatous polyposis (FAP), Hereditary nonpolyposis colorectal cancer (HNPCC)
High risk of malignancy - surgical removal of polyps required
33
Where is mesenteric ischaemia most likely to occur?
Watershed areas such as splenic flexure in the at the borders of territories supplied by superior and inferior mesenteric artery
34
Infective causes of dysentery
E.coli, shigella, campylobacter entamoeba
Low volume bloody diarrhoea and abdo pain
35
E.coli 0157 presentation
HUS
Haemolytic anaemia
AKI
thrombocytopaenia
36
Investigations for lower GI bleeding
Bedside: BP, BM, faecal calprotectin, stool sample, ECG
Bloods: CROSS MATCH
Imaging: erect CXR for air under the diaphragm (perforation), CT/CTA to assess cause and site
Special: flexible sigmoidoscopy (younger patients), colonoscopy (malignancy), upper GI endoscopy, angiographic transaterial embolisation (control massive bleeding)
37
Management of massive lower GI bleeding
ABC resuscitation: two wide bore cannulae, IV saline, bloods (clotting, cross match), possible early blood transfusion, regular monitoring, involve seniors
Localisation: imaging and endoscopy (upper and lower)
Intervention: colonoscopy if stable, coagulation (vasoconstrictors or sclerosing agents), angiography (if colonoscopy is unsuccessful or CI)
38
When would you put a patient with occult bleeding on 2 week wait?
>40 unexplained weight loss and abdominal pain
>50 unexplained rectal bleeding
>60 iron deficiency anaemia or change in bowel habit
Rectal/abdominal mass
<50 rectal bleeding and unexplained symptoms (e.g. weight loss, pain, anaemia)
Unexplained IDA in men or post-menopausal women
39
When should you stop iron tablets prior to endoscopic investigations?
7 days prior
40
What is the cell type characteristically seen in iron deficiency anaemia?
Inherited haemolytic anaemia?
IDA: pencil cells
Haemolytic: spherocytes
41
Management of HUS
IV fluids
Electrolyte correction
AKI management
42
Investigation to carry out should a cause of IDA not be found in LGI tract
Capsule endoscopy (small bowel)
43
Investigations and treatment for acute mesenteric ischaemia
Erect CXR (perforation and 'thumbprinting')
CTA and MRA
IV fluids, NG decompression, anticoagulation
44
Causes of upper GI bleeds (according to anatomical location)
Oesophagus: varices, malignancy, oesophagitis
Gastric: ULCERS, Mallory-Weiss tear, gastritis, malignancy
Duodenal: ulcers, diverticulae, aortoduodenal fistulae
Other: aspirin, NSAIDs
Dieluafoy's lesion (abnormal diameter of blood vessels), Osler-Weber-Rendu Syndrome (epistaxis and GI bleeds), gastric antral vascular ectasia (watermelon stomach)
45
Initial investigation for upper GI bleed
Upper GI endoscopy immediately following resus if unstable (within 24 hours for others)
46
Why might urea be raised in a patient with UGI bleeding?
Digested blood
Hypovolaemic so renin system activated which causes reabsorption of salt, water and urea
47
Imaging in UGI bleed
Erect CXR: perforation (air under diaphragm)
USS/CT depending on aetiology
48
What scoring systems can you use for GI bleeding
Blatchford (initial assessment)
| Rockall (pre and post endoscopy)
49
Treatment of non-variceal upper GI bleeding
Endoscopic: mechanical (e.g. clipping) +/- adrenaline; thermal coagulation + adrenaline
Medical: PPIs (should be post-scope if evidence of recent haemorrhage)
50
Treatment of variceal bleeding of upper GI bleeding
Endoscopic: band ligation
Medical: terlipressin (vasoconstricting and reduces portal pressure), prophylactic abx (risk of spontaneous bacterial peritonitis)
51
Student after night out presenting with vomiting with small amounts of blood following bouts of retching
Mallory-Weiss tear
52
How do NSAIDs cause GI bleeds
Inhibit COX-1
| Increased production of prostaglandins --> increased histamine --> increased HCl production from parietal cells
53
Two types of oesophageal cancer and who is most likely to get them?
Squamous cell carcinoma (upper 2/3): smoker/alcohol
Adenocarcinoma (lower 2/3): hx of GORD leading to columnar metaplasia (Barret's oesophagus)
54
Definition of chronic liver disease
Progressive liver dysfunction over >6 months
55
What are the complications of decompensated liver disease?
Coagulopathy (reduced clotting factor synthesis)
Jaundice (impaired bilirubin breakdown)
Ascites (poor albumin synthesis and increased portal pressure due to scarring)
Encephalopathy
GI bleeding (increased portal pressure leading to varices)
56
Score used for chronic liver disease and what factors does it consider?
Child-Pugh score
Albumin, INR, Bilirubin, encephalopathy, ascites
Class A-C
57
Which patients would you perform a liver biopsy in?
Liver disease with unknown cause
| Differentiating between chronic and acute or fibrosis and cirrhosis
58
What vitamins and minerals are stored in the liver?
Vitamin D
B12 (nerve function and RBC production)
A (retina)
copper
iron
59
Breakdown product of RBC
Haem --> bilirubin --> conjugated in liver --> excreted in bile
60
What are kupffer cells used for?
Phagocytosis to fight infection and breakdown RBCs in the liver
61
Causes of acute hepatitis
Viral
alcohol
drugs
toxins
62
Types of cholestasis
Intrahepatic (inflammation within hepatocytes, PBC, drugs, pregnancy)
Extrahepatic: stones, carcinoma of head of pancreas, sclerosing cholangitis, portal hepatic LN metastases
63
What LFTS will be deranged cholestatic liver disease?
ELEVATION in ALP, GGT +/- bilirubin (if obstructed bile duct)
64
Causes of cirrhosis
Chronic alcohol excess
Persistent Hep B and C
Autoimmune
Inherited metabolic (haemochromatosis, A1AT deficiency, Wilson's)
65
Deranged LFTs in cirrhosis
Synthetic function affected
Hypoalbuminaemia, prolonged PT
66
Where is AST found
Liver
Cardiac muscle
Skeletal muscle (elderly following fall will have raised AST)
67
How do you distinguish between raised AST in liver and skeletal muscle
Creatine Kinase
68
Is AST or ALT more specific?
ALT (mostly found in liver)
69
How can you work out where alkaline phosphatase is coming from?
Gamma GT done also (will be raised if liver problem)
70
Causes of raised alkaline phosphatase in the bone??
Osteomalacia (Vit D deficiency)
Paget's
Malignancy
71
What drugs cause GGT to increase?
Anticonvulsants (CBZ, phenytoin, phenobarb)
Warfarin
Oral contraceptive
72
Gilbert's disease cause
Lacking enzyme to conjugate bilirubin
73
Cause of raised unconjugated bilirubin
Haemolysis:
Sickle cell, thalassemia, spherocytosis, malaria
74
What level of bilirubin would you expect clinical jaundice?
>50umol/L
75
What drugs can cause liver damage?
TB drugs
paracetamol
statins
macrolides
tetracylines
fluclox/amox
HERBAL (St Johns Wart)
76
How is bilirubin excreted normally? What happens in liver disease?
Stercobilinogen and urobilinogen via bowel
In liver disease --> excreted via kidney
77
Causes of isolated raised GGT?
Enzyme-induced (warfarin, OCP)
Alcohol
78
Cause of hepatic encephalopathy?
Increased ammonia as liver is not converting it to urea
79
Why might ALT not be particularly high in cirrhosis?
ALT comes from hepatocytes, but in cirrhosis there is a loss of hepatocytes --> ALT can sometimes go down as a result
80
Causes of raised ALP and GGT?
Cholestasis
81
Cause of raised globulins?
What other tests would you do?
Autoimmune disease
Also do Anti-mitochondrial and smooth muscle ABs
82
What antibody is raised in PBC?
Anti mitochondrial antibodies
83
Why is urine dark in cholestatic liver disease?
Bilirubin excreted in urine
84
Blood investigation for pancreatic cancer?
Ca 19-9
85
Chronic hepatitis - what LFT is raised?
Isolated raised ALT
86
Investigations for Wilson's? Treatment?
Caeruloplasmin (low)
24 hour urinary copper (high)
serum copper (low)
Tx: penicillamine
87
Budd Chiari Triad
Abdominal pain
Hepatomegaly
Ascites
Blockage of hepatic veins
88
Diagnosis and management of H pylori
Rapid urease test (CLO)
| PPI + amoxicillin/metronidazole + clarithromycin
89
What is haemochromatosis and how does it present?
Autosomal recessive condition leading to accumulation of iron
Often unspecific: lethargy, arthralgia
Chronic liver disease, cardiac failure (dilated cardiomyopathy), bronzing of skin, hypogonadism, erectile dysfunction, DM
90
Acute isolated raised ALT >1000U/L associated with AKI?
Ischaemic hepatitis
91
What type of pain would you get with gallstones?
Collicky following eating
92
What other infection risk is there in IVDU with Hep B?
Diagnosis and management?
Hep D (superinfection if following hep B, coinfection if same time)
Dx: reverse polymerase chain reaction of Hep D
Mx: interferon
93
How does carcinoid syndrome present?
Investigation and management?
Flushing, bronchospasm, diarrhoea, hypotension, right heart valve stenosis
Ix: urinary 5-HIAA, plasma chromogranin A y
94
Management of carcinoid syndrome?
Somatostatin analogues
95
How does Wilsons often present?
Liver disease (raised ALT, hepatomegaly, jaundice)
Neuropsych symptoms: change in personality, dementia, Parkinsonism
96
How long must you be eating gluten before TTG and IgA tests?
6 weeks
97
Biopsy finding in oesophageal cancer associated with Barret's/GORD?
Adenocarcinoma
98
What is a pharyngeal pouch and what investigation would you do?
Outpouching at C5/C6
Barium swallow
99
Most common bacterial cause of spontaneous bacterial peritonitis?
E. coli
100
Diagnosis and management of SBP?
Ascitic paracentesis: raised neutrophils
Management: IV CEFOTAXIME
101
Who should you give SBP prophylactic abx to?
>9 Child-Pugh score
| Ascitic fluid protein <15g/L
102
What cancer is associated with achalasia?
Squamous cell carcinoma of oesophagus
103
Investigation and appearance for achalasia?
Barium swallow
Bird beak appearance
104
low MCV and relatively preserved Hb?
Thalassaemia
105
Why do you get a dimorphic blood film in Coeliac disease?
Affects absorption in upper tract, so less iron and folate absorbed
Iron-deficient cells are small, folate deficient cells are big
106
Abdo x-ray showing speckled calcification in midline with pale, offensive stool and long-term abdo pain - likely diagnosis?
Chronic pancreatitis
107
Investigations and findings in Crohn's
CRP
Colonoscopy: deep ulcers and skip lesions
Histology: goblet cells, granulomas, inflammation from mucosa to serosa
Barium enema: fistulae, strictures 'Kantor's string sign', proximal bowel dilation
108
Brown speckled appearance in colonic mucosa? What is a result of?
Melanosis coli
Due to laxative use
109
Crohn's patient with lower right sided abdominal pain relieved on flexion of hip
Psoas abscess (lying on psoas muscle)
110
Diagnostic test for acute pancreatitis
Amylase (at least 3x upper limit)
111
Painless jaundice with hard to flush pale stools - likely diagnosis?
Pancreatic cancer
112
Ascending cholangitis triad
Fever/rigors
RUQ pain
Jaundice
113
What is Murphy's sign and when might it be positive
Arrest of inspiration on palpation of RUQ
Acute cholecystitis
114
What is a gallstone ileus
Obstruction of small bowel secondary to gallstone
Fistula can develop between gallbladder and duodenum
115
Cause of pseudomembranous colitis (both drug and bacteria it promotes)?
Management?
CLINDAMYCIN, PPIs, Cephalosporins (ceftriaxone) --> C.difficile
1st: metronidazole
2nd: vancomycin
Combination if life-threatening
116
First-line treatment of mild-mod UC?
Topical/oral mesalazine (high-dose oral if extensive left-sided
Add oral prednisolone if not
117
firm, smooth, tender and pulsatile liver edge
Right-sided heart failure
118
What change in electrolyte can a PPI cause?
Hyponatraemia
119
Indicators of severe UC flare?
6 loose stools per day/bloody stools + one of:
>90bpm
<105 Hb
Temp >37.8
ESR >30
120
Which TB drug can cause peripheral neuropathy and why?
Isoniazid - causes B6 deficiency
Prescribe pyridoxine hydrochloride to prevent
121
Treatment of hepatic encephalopathy?
Lactulose (inhibits ammonia production by intestine)
2nd: oral rifaximim
122
Management of Barrets oesophagus
High dose PPI
Endoscopic surveillance every 3-5 years (if metaplasia)
If dysplasia:
Endoscopic mucosal resection
Radiofrequency ablation
123
sunburn-like dermatitis rash, diarrhoea and cognitive deficit (dementia/delusion)
Pellagra (B3 deficiency)
124
Treatment of acute alcoholic hepatitis
Oral prednisolone
125
Investigation for primary sclerosing cholangitis? What antibody may be present?
Magnetic resonance cholangiopancreatography
pANCA
126
What vaccine must be given to Coeliac patients?
Pneumococcal every 5 years
127
Treatment of UC if severe relapse or 2 exacerbations in past year?
oral azathioprine or mercaptopurine
128
Hyperparathyroidism and duodenal ulcers - likely diagnosis and treatment?
MEN I
High dose PPI for ulcers
129
severe, colicky post-prandial abdominal pain, weight loss, and an abdominal bruit
Chronic mesenteric ischaemia/intestinal angina
130
Most sensitive blood test for cirrhosis
Platelets (thrombocytopaenia)
131
One unit of alcohol?
25ml single measure of spirits (ABV 40%)
a third of a pint of beer (ABV 5 to 6%)
half a 175ml 'standard' glass of red wine (ABV 12%)
132
AST (<500) greater than ALT (<300), raised GGT
Alcoholic hepatitis
133
Management of variceal bleed
Two large bore cannulae
Blood transfusion <70 Hb
Terlipressin
IV ABx
134
Haemochromatosis treatment?
Venesection
135
Antinuclear or smooth muscle antibodies
Autoimmune hepatitis
136
Patient with UC and isolated raised ALP - what is likely diagnosis?
Primary sclerosing cholangitis
137
How do you define dilatation of the bowel on x-ray?
Diameter (3s)
>3cm small intestine
>6cm large intestine
>9cm caecum
138
What is considered in the True Love and Witts score for UC?
Bowel movements per day
Blood in stool
```
SEVERE
ESR >30
Pyrexia >37.8
Anaemia
Pulse >90
```
139
Treatment of severe presentation of UC
IV steroids
IV ciclosporin if no change after 72 hours
140
Raised antimitochondrial antibodies - likely diagnosis?
Primary Biliary Cirrhosis
141
Management of AI hepatitis
Steroids +/- immunosuppressants e.g. azathioprine
142
Features of AI hepatitis
FEMALE COMMON
Amenorrhoea
Chronic liver disease signs
Fever/jaundice
Biopsy: inflammation extending beyond limiting plate 'piecemeal necrosis'
143
Antibodies in AI hepatitis
Type 1: ANA and ASMA
Type 2: LKM1 (just kids)
Types 3: soluble liver-kidney antigen (middle-aged)
144
GORD complications
```
oesophagitis
ulcers
anaemia
benign strictures
Barrett's oesophagus
oesophageal carcinoma
```
145
GORD treatment
High-dose PPI 1-2 months
Lower if response
Double dose for a month if no response
H2RA or prokinetic if endoscopically negative reflux
146
Primary biliary cirrhosis Ms
anti-mitochondrial
Middle aged women
IgM
147
Which drugs have a high risk of duodenal ulcers?
SSRIs
NSAIDs
steroids
148
What is hepatorenal syndrome and how is it treated?
Vasodilation and underperfusion of kidneys
Treatment: terlipressin, albumin and TIPSS
Transplant definitive
149
Mesalazine use and side effects
Used for mild-mod UC
SE: nausea, vomiting, diarrhoea, ACUTE PANCREATITIS
150
Causes of liver decompensation in cirrhosis
```
Constipation
Infection
Electrolyte imbalance
Dehydration
GI bleed
Alcohol
```
151
IgM chronic or acute?
Acute
152
NAFLD LFTs
ALT>AST
153
Investigations and management following incidental finding of NAFLD
Enhanced liver fibrosis blood tests
FIB4/NAFLD score with FibroScan
Management: lifestyle changes, gastric-banding, insulin-sensitising drugs
154
Non-tender hepatomegaly with hard, irregular liver edge
Metastatic cancer or primary hepatoma
155
What is the Mackler triad for Booerhave syndrome?
Vomiting, subcutaneous emphysema, thoracic pain
MIDDLE AGED ALCOHOL
Severe vomiting --> oesophageal rupture
156
Initial management of Crohn's
Hydrocortisone (budesonide is alternative)
Enteral feeding
2nd line: 5-ASAs (mesalazine)
Add-on: azathioprine or methotrexate
Infliximab if refractory
157
Treatment of isolated peri-anal Crohn's
Metronidazole
158
What is metoclopramide used for and when should you avoid it?
D2 antagonist, anti-emetic and prokinetic
Used for: nausea, GORD and gastroparesis
Avoid in: bowel obstruction
Extrapyramidal side effects
159
4 grades of hepatic encephalopathy
I: irritability
II: confusion, inappropriate behaviour
III: incoherent, restless
IV: coma
160
Plummer-Vinson syndrome triad?
Glossitis
Dysphagia
Iron-deficiency anaemia
+/- chialitis
161
Cancers most commonly associated with hereditary non-polyposis colorectal cancer
Colorectal
| Endometrial
162
What symptoms warrant urgent referral for endoscopy?
Dysphagia
Upper abdo mass
>55 with weight loss + dyspepsia, upper abdo pain or reflux
163
What symptoms warrant NON-urgent referral for endoscopy?
Haematemesis
Treatment-resistant dyspepsia
Upper abdo pain with low Hb
Raised platelet with abdo symptoms
164
Hx of AF, lactic acidosis, raised WCC and abdominal pain?
Acute mesenteric ischaemia
165
Cause of pigmentation of bowel mucosa and pigment-laden macrophages within the mucosa on PAS staining
Laxative abuse leading to melanosis coli
166
What is Rovsing's sign
Palpation of LIF leads to referred pain in RIF due to appendicitis
167
How does the oral contraceptive pill cause cholestasis?
Oestrogens prevent the release of bile acids and conjugated bilirubin leading to a build up and diffusion into blood stream
INTRA-HEPATIC JAUNDICE
168
Iron deficiency anaemia following FBC - what's next investigation
Ferritin (IDA if <15mcg/L)
Total iron binding capacity, iron or transferrin if co-existing malignancy, liver disease or hyperthyroidism as can taint findings
169
What is the double duct signs and what is it associated with
Dilatation of pancreatic and common bile ducts
Pancreatic cancer
170
What blood test is used to measure hepatocellular carcinoma recurrence?
Alfa fetoprotein (produced by regenerating liver cells)
171
Conditions associated with gallstones
Oral contraceptive
Sudden weight loss
Crohn's (ileitis leading to reduced absorption of bile salts)
Diabetes
