Biliary disease Flashcards
Primary sclerosing cholangitis =
Stricturing and fibrosis of intra/extrahepatic bile ducts -> leads to obstruction of bile movement
Autoimmune aetiology
If a patient with UC starts to have liver related disease think ->
Primary Sclerosing Cholangitis
How does PSC lead to cirrhosis
Back pressure of bile due to strictures -> inflammation of liver (hepatitis) -> fibrosis and eventually cirrhosis
PSC is commonly seen in which IBD
UC
Risk factors for PSC
Male
Aged 30-40
Likely to already have UC
FHx of PSC
PSC presentation
Cholestasis = Jaundice and pruritus
CHRONIC RUQ pain
Hepatomegaly
Fatigue
What might you see with LFTs in PSC
ALP ↑ Bilirubin ↑
Which Antibodies might be raised in PSC
ANCA (Anti-neutrophil cytoplasmic Ab)
Anti-smooth muscle cell antibodies
Investigation for PSC
ERCP or MRCP (MRI of liver, bileducts and pancreas)
Strictures will be seen (Beaded appearance)
Management of PSC
ERCP (dilate and stent strictures)
Cholestyramine
Main difference between biliary colic and cholecystitis
Biliary colic - pain only, NO fever
Acute cholecystitis - pain and fever
Charcot’s triad and what is it for?
RUQ pain, fever, jaundice
Ascending cholangitis
Treatment of ascending cholangitis
IV ABX
ERCP to relieve obstruction after 24-48hrs
Main differentiating factor between cholangitis and cholecystitis
Jaundice seen in 60% of pts with cholangitis and not often seen in cholecystitis
(Cholecystitis usually causes blockage of cystic duct - doesn’t cause obstructive jaundice like cholangitis)
Murphy’s sign indicates what?
Acute cholecystitis
Arrest of inspiration on palpation of the RUQ
Management of acute cholecystitis
IV ABX
Laparascopic cholecystectomy within 1 week of diagnosis
Main 2 causes of acute pancreatitis
Alcohol and gallstones
What sign’s might be seen on examination for acute pancreatitis?
Cullen’s sign - Periumbilical discolouration
Grey Turner’s sign - Flank discolouration
Glasgow scale of Pancreatitis Severity (PANCREAS)
What are the parameters
PaO2 < 7.9kPa Age > 55 years Neutrophils (WBC > 15) Calcium < 2 mmol/L Renal function: Urea > 16 mmol/L Enzymes LDH > 600IU/L Albumin < 32g/L (serum) Sugar (blood glucose) > 10 mmol/L
What bacterium usually causes asc. cholangitis?
E. coli
Painless jaundice and palpable gallbladder (Courvoisier’s Law) is likely indicative of …
Pancreatic cancer
Gradual onset of obstructive symptoms (pain, jaundice, fever) could indicate what?
Cholangiocarcinoma
What is Mirizzi syndrome
When a gallstone in the cystic duct (usually causing cholecystitis) starts compressing and blocking off the common duct causing jaundice
One of the rare times cholecystitis may present with jaundice
Investigations for biliary pathology
1) Bloods (LFTs, inflammatory markers, WCC)
2) Abdominal US - presence of gallstones, may visualise pancreatic masses and other lesions
3) MRI/ MRCP for liver tumours and cholangiocarcinoma and sometimes preferred for gallstones over US
