Biliary and Liver Flashcards
How should you classify jaundice?
Pre-Hepatic
Hepatic
Post-Hepatic
Which signs are associated with Cirrhosis?
Jaundice
Spider Naevi
Ascites
Asterixis
Bruising
Clubbing
Palmar Erythema
Gynaecomastia
What are the key features of Hepatitis A?
Oro-Anal Sex
Faeco-Oral Spread
Acute, typically asymptomatic
Common in Asia & Africa
Improperly claned Shellfish
What are the key features of Hepatitis B?
Requires Serology
Most adults clear it, never causes Acute Hepatitis
What are the key features of Hepatitis C?
Spread through blood products.
Adults who contract it become Chronic Carriers.
Associated with the development of Hepatocellular Carcinomas.
What are the key features of Hepatitis D?
Requires co-infection with Hep B
What are the key features of Hepatitis E?
Faeco-Oral transmission
Acute, self-limiting
Immunocompromised patients at risk of chronic infection.
High morbidity in pregnant women.
What are the typical presenting symptoms of Viral Hepatitis?
Nausea and Vomiting
Fever
Jaundice
RUQ Pain
(Raised AST/ALT)
What does a patient’s HbsAg status indicate?
-ve = Immune: Cleared infection/past vaccine
+ve = Acute/Chronic Infection
What could be the cause of ALT/AST readings in the 1000s?
Paracetamol Overdose
Acute Viral Hepatitis
Ischaemia
What does it indicate when the AST:ALT ratio is 2:1?
Alcoholic Hepatitis
How does Non-Alcoholic Steatohepatitis typically present?
Typically an old, fat man
Elevated fasting triglycerides, with low HDL
High ALT/AST
Asymptomatic
Detected on incidental Liver USS
What are the main types of Alcoholic Liver Disease?
Alcoholic Fatty Liver Disease
Alcoholic Hepatitis
Cirrhosis
What is Wilson’s Disease?
Impaired excretion of Cu from the liver via Bile.
Copper then accumulates in the Liver, Basal Ganglia and Cornea.
How does Wilson’s Disease typically present?
In SBAs - Individual with acute liver & neurological Sx
Keyser Fleischer Rings
How would you investigate suspected Wilson’s Disease?
Low serum Caeruloplasmin
High Urinary Copper
Low Serum Copper
What is Haemochromatosis?
Multisystem disorder of dysregulates increased dietary iron absorption and increased iron release from macrophages.
Autosomal Recessive
How does Haemochromatosis typically present?
Fatigue, Arthralgia
Bronze Skin
Diabetes
Hepatomegaly
MCP Arthritis
Describe the Haematinics seen in a case of Haemochromatosis.
Low Transferrin
High Ferritin
Low TIBC
What are the main risk factors for Gallbladder Disease?
Fat
Female
40
FHx
What is Biliary Colic?
Stone impacted in ‘Hartman’s Pouch’. The Gall Bladder spasms against this obstruction, leading to colicky RUQ pain.
What is Acute Cholecystitis?
Gall Bladder Inflammation.
RUQ Pain + Fever + WBCs
Murphy’s Positive
What is Cholangitis?
Inflammation of the Biliary Tree.
Charcot’s Triad = RUQ Pain + Fever + Jaundice
How would you investigate suspected Gallbladder Disease?
LFTs
ABDO USS
Consider MRCP
What do LFTs show in Cholethiasis?
LFTs within normal ranges.
How would you manage a case of Cholelithiasis?
Cholecystectomy
How would you manage a case of Choledocholithiasis?
ERCP
What is Primary Biliary Cholangitis (Formerly Cirrhosis)?
Chronic Inflammatory Liver Disease involving progressive destruction of the intrahepatic bile ducts.
This leads to cholestasis and cirrhosis.
What is Primary Sclerosing Cholangitis?
A chronic cholestatic liver disease characterised by progressive inflammatory fibrosis and obliteration of intrahepatic and extrahepatic bile ducts.
How does a typical PBC patient present?
‘Itchy Females, with fatigue, dry eyes and a dry mouth’
How does a typical PSC present?
People with Ulcerative Colitis in their 40s-50s.
Fatigue
RUQ Discomfort
Pruritus
Jaundice
How would you investigate a suspected case of PBC?
Anti-Mitochondrial M2 Antibodies
How would you investigate a suspected case of PSC?
MRCP - ‘Beads on a String’ Appearance
What does PBC tend to be associated with?
Hypercholesterolaemia
Tendon Xanthomata
Xanthelasma Periocular
How does Pancreatic Cancer present?
Painless Jaundice
FLAWS
How would you investigate a suspected case of Pancreatic Cancer?
LFTs
Protocol CT Scan
Describe the Aetiology of Hepatocellular Carcinoma.
Chronic Liver Damage (ETOH, Hep B/C, Autoimmune)
Metabolic Disease
Alpha-1 Antitrypsin Deficiency
How would you investigate a possible case of Hepatocellular Carcinoma?
Urgent direct access USS
LFTs
Clotting Profile
Alpha-Feroprotein
What is a Cholangiocarcinoma?
Primary Adenocarcinoma of the Biliary Tree
CA 19-9
