Biliary Disease

Question 1

How do you differentiate biliary colic from acute cholecystitis?

Answer 1

DOES NOT INCLUDE FEVER/RAISED WCC/LOCAL PERITONISM

Question 2

Investigations in Biliary colic (5, bloods all count as 1)

Answer 2

Urinalysis
CXR
ECG
Ultrasound
Bloods (LFTs, INR, FBC)

Question 3

How to manage biliary colic?

Answer 3

Cholecystectomy

Question 4

Key symptoms of chronic cholecystitis?

Answer 4

RUQ Pain
Nausea
Vomiting 
Fat intolerance
IBS

Question 5

Investigation for chronic cholecystits?

Answer 5

USS

MRCP

Question 6

Three risk factors for acute cholecystiits?

Answer 6

Gallstones, Obesity, rapid weight los

Question 7

What is Murphy’s sign?

Answer 7

Murphy’s sign - Two fingers on RUQ and ask patient to take deep breath in. Pain & arrest of inspiration is positive.

Question 8

4 investigations for acute cholecystitis?

Answer 8

FBC
LFTs
Ultrasound
HIDA cholescintigraphy
MRCP

Question 9

Management acute cholecystitis?

Answer 9

Cholecystectom

Laparotomy Cholecystectomy

Question 10

What are 5 symptoms of ascending cholangitis?

Answer 10

Reynold’s Pentad
RUQ pain
Fever
Jaundice
Hypotension
Confusion

Question 11

Three bacteria which cause ascending cholangitis

Answer 11

Klebsiella spp., Escherichia coli, Enterobacter spp

Question 12

Blood tests for ascending cholangitis (5)

Answer 12

FBC (raised WCC) 
ESR & CRP
LFTs
U&Es
Amylase

Question 13

Imaging for ascending cholangitis (3)

Answer 13

Ultrasound
Abdominal x-ray
Contrast enhanced CT

Question 14

What is primary biliary cirrhosis? (which bit of liver does it effect?)

Answer 14

Autoimmune disorder of biliary system involving destruction of canals of Hering (interlobular bile ducts). Causes intrahepatic cholestasis.

Question 15

Give four core symptoms of PBC

Answer 15

Fatigue
Pruritius
RUQ
Jaundice later

Question 16

What are 3 signs of PBC

Answer 16

Hepatomegaly occurs in 25%.
Hyperpigmentation occurs in 25%.
Splenomegaly occurs in 15%.
Jaundice occurs in 10%.
Xanthelasma may occur in the later stages.

Question 17

What core super important antibody is involved in PBC?

Answer 17

Antimitochondrial antibody

Question 18

What tests would you do in PBC other than antibody screening?

Answer 18

LFTs
IGM
Ultrasound
Cholangiography
Liver biopsy

Question 19

Two possible treatment for PBC

Answer 19

Symptomatic - cholestyramine for pruritus

Liver transplant

Question 20

What autoimmune conditions are associated with PBC?

Answer 20

Coeliac’s
CREST
Thyroid

Question 21

What is primary sclerosing cholangitis associated with

Answer 21

Inflammatory bowel disease!¬

Question 22

What part of the liver does primary sclerosing cholangitis effect?

Answer 22

Intra- and extra- hepatic bile ducts

Question 23

Give four key symptoms of PSC

Answer 23

Pruritis
Jaundice
RUQ pain
Fatigue, weight loss, shivers

Question 24

What is raised in PSC that isn’t raised in PBC?

Answer 24

Alkaline phosphatase

Question 25

Investigations for PSC?

Answer 25

``` LFTs PTT IgG & IgM p-ANCA MRCP Liver biopsy ```

Question 26

Management for PSC?

Answer 26

``` Pruritis Cholestyramine/Rifampicin/SSRI Prevent progression ADEK supplements Avoid alcohol ```