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NnD > Hepatobiliary disease and anaemia > Flashcards

Hepatobiliary disease and anaemia Flashcards

1
Q

Where does pancreatic duct meet the common bile duct

A

at the level of the ampulla

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2
Q

what are the three types of jaundice and what do they mean, what type of bilirubin involved

A

Pre-hepatic , increased bilirubin production exceeds ability of liver to conjugate, unconjugated bilirubin

Hepatic, mixed bilirubin, can’t take up bilirubin fully but also can’t conjugate, due to hepatocyte damage

Post hepatic, conjugated bilirubin, due to obstruction

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3
Q

Causes of hepatic jaundice

A
  • Viruses – hepatitis, CMV, EBV
  • Drugs: paracetamol, anti-TB,
  • Alcohol
  • Cirrhosis, autoimmune diseases
  • Sepsis
  • Right heart failure ⇒ Due to pressure generated
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4
Q

Classification of post hepatic jaundice

A
  • Within the lumen ⇒ of billary system
  • Within the wall ⇒ Tumour
  • External compression ⇒ Pancreatic cancer
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5
Q

do gall stones cause painful of painless jaundice

A

Painful jaundice

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6
Q

Clinical presentations of gallstones (4)

A
  • Biliary colic
  • obstructive jaundice
  • Acute Cholecystitis
    • Pain might start colicky and become more constant, may have temperature
    • Treated with antibiotics, may be taken out by surgery
  • Can have inflammation and infection
    Acute pancreatitis
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7
Q

Most common presentation of gallstones

A
  • After fatty foods, colicky pain
    • Gallstones may be trapped at top, spasming after eating
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8
Q

Management of gallstones

A
  • Analgesia
  • ? Antibiotics ⇒ For acute cholecystitis or infection on top of gallstones in bile duct
  • Percutaneous drainage ⇒ If not fit for GA to remove gallbladder, have to just stick a drain in under US guidance
  • ERCP ⇒ If jaundiced and in emergency especially
  • Surgery ⇒ may use laparoscopic cholecystectomy to get gall bladder out especially for billary colic
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9
Q

what is hilar lymphadenopathy

A

compression of nodes around hilum

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10
Q

What is a cholangiocarcinoma and what are the two types

A

Tymour of bile duct. Hilar and distal

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11
Q

is tumour of head of pancreas painless or painful. Symptoms?

A

painless jaundice , weight loss, back pain

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12
Q

Symptoms of ampullary lesions. Painful??

A

Painless, weight loss

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13
Q

Treatment of carcinomas causing jaundice, when can they be used

A

Resection - for distal cholangiocarcinoma, ampullary tumours, pancreatic tumours ( excision of gallbladder, duodenum and head of pancreas, part of stomach)
ERCP - if pancreatic cancer has spread and have liver or lung metastasis. Endoscopy to put stent through cancer, allowing bile to drain
Can also be used for gall stones that have fallen out of gallbladder

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14
Q

Features of obstructive jaundice

A
  • Pale stool ⇒ Really pale stool due to bilirubin not reaching the stool
  • Dark urine ⇒ Bilirubin can spill out into blood and be excreted by kidneys
  • Itchy due to bile salts getting into skin
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15
Q

Examination of jaundiced patients

A
  • Peripheral stigmata of liver disease: (cirrhosis)
    • finger clubbing, palmar erythema, dupuytren’s, sclera for jaundice, Virchow’s nodes in left supraclavicular fossa (sign of liver cancer), spider naevi, gynaecomastia
  • Hepatomegaly
  • Splenomegaly (portal hypertension)
  • Ascites
  • Palpable Gallbladder in cancers especially
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16
Q

If anaemic in jaundice what could this possibly be

A

cancer

17
Q

Abnormal clotting in jauncide- what could this be

A

liver disease

18
Q

What does high bilirubin with ALP >ALT/AST
and ALT/AST > ALP mean?

A

Obstructive picture
Liver disease eg. hepatic jaundice

19
Q

What imaging should be used for jaundice

A
  • Ultrasound⇒ Good to differentiate post hepatic cause = ducts will be blown up
    • ?gallstone ?CBD dilatation
      ?Liver/pancreas mass
  • CT abdomen with contrast ⇒ To check for cancer if hepatic cause
  • MRI/MRCP ⇒ Can show stones in bile duct itself
  • Tissue biopsy: USS or CT guided ⇒ May be used after CT or MRCP
20
Q

Management of jaundice

A
  • Depends on underlying condition
  • Treat symptoms:
    • Analgesia
    • IV fluids
    • Antibiotics if septic
    • Vitamin K & chlorphenamine ⇒ clotting and itch
  • Treat underlying cause
    • Pre-hepatic: stop haemolytic process
    • Hepatic: anti-virals, prevent deterioration of cirrhosis, eg alcohol, drugs
    • Obstructive causes: ERCP/stenting, surgery ( to cut out cancer if possible), palliation
21
Q

What is the definition of anaemia

A

where serum haemoglobin levels are 2 standard deviations below the normal

22
Q

How is haem iron and non-haem iron absorbed from stomach

A

Haem- containing Fe2+ is hydrolysed from globin, Some Fe3+ (Non-haem iron) is reduced to Fe2+ in acidic conditions of the stomach but at a much lower rate

23
Q

What happens to haem and non haem iron in small intestine

A

Fe2+ remains soluble as it is bound to proteins and gets absorbed through enterocytes. Some Fe3+ forms insoluble complexes at the high Ph conditions of the small intestine and this lowers absorption rates and increases excretion

24
Q

DELETE

A

Duodenum

25
Q

Where is iron absorbed in the SI and transported to

A

Duodenum to Muscle, liver, bone marrow, spleen

26
Q

What can help absorption of iron

A

Vitamin C

27
Q

What is the marker of iron stores in cells

A

Ferritin

28
Q

What is one inhibitor of fe2+ absorption

A

tannins, polyphenols

29
Q

What is IDA defined as

A

Low haemoglobin in the presence of either Low ferritin or Low serum iron in the presence of high transferrin

30
Q

What are main types of causes of IDA

A

Main causes can be loss of iron, malabsorption, poor dietary intake, increased demand

31
Q

Main causes of loss of blood causing IDA

A
  • Menstrual blood loss
  • GI blood loss,
  • Renal tract blood loss
  • Cancer
  • Menstrual blood loss is the commonest cause overall
  • If cancer may find blood mixed in stool
32
Q

Causes of malabsorption of iron

A

previous gastric surgery, Coeliac disease

33
Q

Common symptoms of IDA:

A

tiredness, dyspnoea, headache

34
Q

common signs of IDA

A

pallor, atrophic glossitis

35
Q

What is the main investigation of IDA and how does it differ btw different groups

A

If no GI symptoms, no FHx of GI disease, and pre-menopausal woman just need coeliac serology
If asymptomatic IDA BUT man or post-menopausal or non-menstruating⇒ Gold standard is endoscopy and colonoscopy

36
Q

Treatment for IDA and side effects

A
  • Optimise diet
  • Oral iron supplementation for 3 months after iron deficiency corrected
  • Main side effects are constipation, GI upset and dark stools
37
Q

does giving iron help in ACD and why

A

No, as there is reduced release of iron from RES due to increased hepcidin
Reduced RBV due to reduced erythropoietin

38
Q

How do ferritin stores and transferrin levels and hepcidin vary in IDA and ACD

A

low in IDA, high in ACD
High and low/normal
low, high

NnD (10 decks)

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