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MedEd Tutorials > 23. Biliary/Liver 1 > Flashcards

23. Biliary/Liver 1 Flashcards

1
Q

Causes of jaundice split into three categories?

A

Pre-hepatic (would be unconjugated) - haemolytic anaemia or gilbert’s
Hepatic (mixed bilirubin) - hepatitis (viral, alc, AI, drug), cirrhosis

Obstructive/cholestasis - liver mass, gallstones, pancreatic cancer, drug

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2
Q

What would be seen in pre-hepatic vs obstructive causes of jaundice on presentation?

A

Pre - normal urine
Ob - dark urine as conj bilirubin goes into the urine
Pale stools and also pruritus

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3
Q

Investigations in jaundice?

A

Bilirubin (pre hep has this raised ONLY)
AST/ALT (hep)
ALP/GGT (obstructive)

PT and albumin - markers of function!!

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4
Q

What does a raised AST/ALT mean?

A

Hepatocyte damage, this is a hepatic picture

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5
Q

What causes hepatitis?

A 
Alcoholic
NASH
Viruses
Drugs
Autoimmune
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6
Q

Hepatitis symptoms?

A 
RUQ pain
Jaundice
Hepatomegaly
Joint pain
Nausea
Fatigue
Dark urine

Acute - short recovery or progression to chronic
Chronic - over 6 months

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7
Q

What are the three spectrums of alcoholic liver disease?

A

Steatosis - a few days of heavy drinking, no symptoms that is reversible
Alcoholic hepatitis - long term alcohol use or persistent binge drinking, nausea, anorexia, weight loss, hepatomegaly, fever, jaundice etc. due to inflammation
Cirrhosis

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8
Q

Investigations for alcoholic hepatitis?

A

FBC - macrocytic anaemia
LFTs - AST>ALT, raised bili, ALP, GGT and low albumin
Raised PT

Hepatic USS
Liver biopsy - ballooning
Mallory bodies indicate hepatitis

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9
Q

How do we manage alc hep?

A

Alc abstinence with chlordiazepoxide (benzo)
Nutrition - thiamine
Weight loss/stop smoking
Steroids in severe, maddrey score

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10
Q

What can cause NASH?

A 
Non-alcoholic fatty liver disease
Obesity 
Diabetes
Hyperlipidaemia 
HTN
etc.
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11
Q

Signs of insulin resistance (for NASH)?

A

Polyuria
Polydipsia
Acanthosis nigricans

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12
Q

How to manage NASH?

A

Manage causes

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13
Q

Viral hep A and E spread and management?

A

fAEco-oral spread
Stop drinking and

These are acute

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14
Q

How to tell between A and E on serology?

A

A - IgM high during, IgG persists for life

E - same but IgM is high for 2 months, around 6 weeks for A. IgG only persists for years

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15
Q

Hep B and C, how are they different to A and E?

A

They can be acute but mostly chronic.
B likely to stay acute.
B has coinfection with D

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16
Q

What is seen in hep B serology?

A

Surface antigen and core antigen on hep B!

In response we produce surface antibody and core antibody. We vaccinate to produce the surface antibody.

Surface antibody - vaccinated or previous infection
Core antibody - actually has infection
If they have HBsAg (the actual hep b antigen) then it’s happening rn needs these below to differ:

IgM - acute
IgG - longer term

Surface - Anti-HBs
Core - Anti-HBc

17
Q

What happens in liver cirrhosis?

A

Normal liver replaced with fibrosis ad nodules of regenerating hepatocytes.

Alc misuse, viral hep, autoimmune, haemochromatosis etc.

18
Q

Signs of chronic liver disease/cirrhosis?

A 
Clubbing
Spider naevi (at least 3)
Palmar erythema
Gynaecomastia
Bruising
Dupytren's contracture
19
Q

What is portal hypertension?

A

Liver is cirrhotic so increased pressure in portal vein.
Blood flows from portal to systemic circulation.
Can cause - distended veins (varices), ascites, splenomegaly, caput medusae

20
Q

How to manage cirrhosis?

A

Treat cause and avoid hepatotoxic drugs e.g. NSAIDs

Monitor risk of complications (SBP (infection of ascites), encephalopathy, ascites

21
Q

How to manage complications of cirrhosis?

A

Encephalopathy - protein restriction, oral lactulose, oral rifaximin, phosphate enema but avoid sedatives
Ascites - sodium restriction, diuretics, paracentesis
SPB (>250 neutrophils) - Abx (cefotaxime)
Varices - monitor needs own page

22
Q

How to treat varices?

A

Prophylaxis - beta blocker
Rupture - ABCDE, fluids, bloods, terlipressin and Abx, ligation
Secondary prophylaxis - beta blocker

TIPS procedure

23
Q

What is cholelithiasis?

A

Gallstone in gallbladder (no jaundice)

24
Q

What is biliary colic?

A

Gallstones in bladder or CBD causing pain (no jaundice)

25
Q

What is acute cholecystitis?

A

Gallstone in gallbladder causing inflammation - can be secondary to an infection (no jaundice unless meritzis)

26
Q

How do we treat cholelithiasis, biliary colic and acute cholecysitits?

A

1 - incidental no Mx
2 - analgesia and elective lap chole
3 - clear fluids, analgesic, fluid resus with IV abx with elective lap chole

27
Q

What is choledocholithiasis?

A

Gallstone in CBD (jaundice)

28
Q

What is ascending cholangitis?

A

Infection of the biliary tree (jaundice)

29
Q

When would we do ERCP?

A

Biliary colic if in CBD
Choledocholithiasis (with analgesia
Ascending cholangitis

30
Q

What is charcot’s triad?

A

RUQ pain
Jaundice
Fever

Signs of asce cholangitis

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