80. Biliary tract Flashcards
Most common hepatitis
A, B, C
RF for hep A
o Fecal oral o Blood is rare o Many cases asymptomatic o Vaccines for MSM IVDU Drug users o 30 day incubation
RF for hep B
o Secreted into serum of infected person
o Highest rates in MSM and IVDU
o Salive, semen, stool, tears, urine, vaginal
o 10% of adults become chronic carriers
RF for hep C
o Used to be blood transfusions
o Now IVDU and > 20 sex partners
o Short acute phase, then chronic phase
Read indications for HbIG and vaccine
In chapter
Lab findings in alcholic hepatitis
- Moderate AST/ALT rise, but over 10x unusual
- Bili is usually elevated
- WBC 10-20
- INR gives idea of dysfunction
MGMT of EtOH hepatitis
- IVF and lyte mgmt.
- Antiemetics
- May have hypoglycemia, and need glucose
o Give thiamine - Give Mg unless contraindicated
MGMT of variceal bleed
o Octreotide o Vasopressin o Balloon tamponade o Possible TIPS procedure later - PLTs if <50 - possible vit K
Labs in cirrhosis
- AST/ALT rarely more than minimal increase
- Bili often not high until very advanced
- ALP out of proportion suggests
- Coag changes
Meds for SBP
ceftriaxone
albumin 1g/kg
Possible causes of hepatic encephalopathy
GI bleed Lyte abnormalities VTE Ileus and constipation sedative meds dehydrations AKI infection
MGMT of hepatic encephlopathy
- Control airway PRN
- Address lytes and GI bleeding
- Stop all CNS depressants
- Lactulose 30-60 until poo
- Oral aminoglycocide with flagyl may help reduce ammonia procuding bacteria in gut
Indication to start ABx in SBP
WBC > 250 in tap
Presentation of pyogenic abscess
- RUQ pain, fever, N/V
- Ill appearing
- Acute
Labs of pyogenic abscess
- ALP and bili elevated
- Leukocytosis
- AST/ALT 2-4x normal
MGMT of pyogenic abscess
- Ceftri and flagyl
- Possible add vanco
- > 3cm requires drainage
presentation of amebic abscess
- Acute
- Fever, NV and abdo pain
- Diarrhea common in children
MGMT of amebic abscess
- Flagyl 750 TID for 7-10 days
- Drain only for refractory cases
Presentation of cholestatis of preg
- In third trimester
- Progressive pruritus
- Bili may have mild elevation
What is budd-chiari
- Hepatic venous outflow obstruction above the hepatic venules
- Associated with hypercoagulable states
- Can cause acute obstructive states and acute livers failure
- Newly Dx may need TIPS procedure
2 types of gall stones
Cholesterol Usually due to elevated levels in bile acids RF • Age • Female • obesity Pigmented • usually due to infections
MGMT of cholecystitis
- Fluids and pain control
- Usually start on tazo
o Until surgery
US findings of cholecytitis
o Stones, thickened wall, pericholecystic fluid
Patho of cholangitis
- Acute obstruction usually due to stone, but also tumor or stricture
- Also have elevated luminal pressure and infection
- Retrograde infection
Triad of cholangitis
Fever
RUQ
jaundice
Pentad of cholangitis
Fever RUQ jaundice AMS Hypotension
MGMT of cholangitis
Fluids
Pressors PRN
Tazo
