Hepatobiliary Flashcards

1
Q

What is cholestasis?

A

Blockage of the flow of bile

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2
Q

What is cholelithiasis?

A

Gallstone(s) are present

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3
Q

What is choledocholithiasis?

A

Gallstone(s) present in the bile duct

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4
Q

What is biliary colic?

A

Intermittent RUQ pain caused by gallstones irritating the bile ducts

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5
Q

What is cholecystitis?

A

Inflammation of the gallbladder

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6
Q

What is choleangitis?

A

Inflammation of the bile ducts

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7
Q

What is a cholecystectomy?

A

Surgical removal of the gall bladder

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8
Q

What is a cholecystostomy?

A

Inserting a drain into the gallbladder

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9
Q

What are the risk factors for developing gallstones? (4 Fs)

A

Female
Forty
Fertile
Fat

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10
Q

What are the features of biliary colic?

A

Severe, colicky epigastric or RUQ pain
Often triggered by fatty meals
Can be associated with N+V

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11
Q

What can a raised ALP indicate?

A

Problems with the liver or bone
Biliary obstruction, liver/bone malignancy, primary biliary cirrhosis, Pagets etc.
Can also be raised in pregnancy as placenta releases it

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12
Q

What LFTs are useful markers of hepatocellular injury?

A

ALT
AST

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13
Q

What would this picture indicate?
Slightly raised ALT and AST
Higher rise in ALP

A

An obstructive picture in the hepatobiliary system e.g. gallstones

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14
Q

What would this picture indicate?
Raised ALT, AST and ALP?

A

A problem in the liver itself

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15
Q

What are the complications of ERCP?

A

Excessive bleeding
Cholangitis
Pancreatitis

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16
Q

What is the treatment of gallstones?

A

Asymptomatic - conservative, no intervention required
Symptoms or complications - Cholecystectomy

17
Q

What is acute cholecystitis?

A

Inflammation of the gallbladder which is caused by a blockage of the cystic duct, preventing the gallbladder from draining
95% of cases are caused by gallstones

18
Q

What are the features of acute cholecystitis?

A

RUQ pain
Fever
+ve Murphey’s sign
Occasionally slightly deranged LFTs
Raised inflammatory markers and WBCs

19
Q

What is murphy’s sign?

A

Place hand in RUQ and apply pressure
Ask patient to take a deep breath in
Gallbladder moves down with inspiration and comes into contact with hand
Results in acute pain

20
Q

What is the management of acute cholecystitis?

A

US to confirm gallstones
Cholecystectomy, ideally within 48 hours of symptoms

21
Q

What are the features of acute cholangitis?

A

Charcot’s Triad
- Fever
- RUQ pain
- Jaundice (raised bilirubin)

22
Q

What are the 2 main causes of acute choleangitis?

A

Obstruction in the bile ducts stopping bile flow (e.g. gallstones in the bile duct)
Infection induced during an ERCP procedure

23
Q

What are main causative organisms of ERCP?

A

E. Coli
Klebsiella species
Enterococcus spieces

24
Q

What is the management of acute cholecystitis?

A

Fluid resus
Antibiotics (Amox, Met and Gent)
Early ERCP
PTC where ERCP is not suitable

25
Q

What is PTC?

A

Percutaneous transhepatic cholangiogram (PTC)
Insertion of drain through skin and liver, into bile ducts
Relives immediate obstruction and stent can be placed

26
Q

What is cholangiocarcinoma?

A

Cancer of the bile duct

27
Q

What type of tumour are a majority of cholangiocarcinomas?

A

Adenocarcinoma

28
Q

What is the main risk factor for developing cholangiocarcinoma?

A

Primary sclerosing cholangitis

29
Q

What are the features of cholangiocarcinoma?

A

Persistent biliary colic symptoms
Anorexia, jaundice and weight loss
Palpable mass in RUQ
Periumbilical lymphadenopathy (sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow’s node)
Raised CA 19-9 levels

30
Q

What is Courvoisier’s Law?

A

The presence of a palpable gallbladder in the presence of jaundice is unlikely to be gallstones

More likely to be a cancer of the head of the pancreas or a cholangiocarcinoma