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GI: Key Information > Biliary System > Flashcards

Biliary System Flashcards

1
Q

define primary biliary cholangitis (PBC)

A

autoimmune disease associated with progressive destruction of the bile ducts, due to granulomatous inflammation

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2
Q

what is PBC associated with?

A

rheumatoid arthritis

Sjogren’s syndrome

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3
Q

presentation of PBC

A
  • fatigue
  • itch without rash
  • xantheslama and xanthomas
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4
Q

diagnosis of PBC

A 
anti-mitochondrial antibodies (AMA)
LFTs (cholestatic)
liver biopsy (non-caseating granulomas)
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5
Q

management of PBC

A

urseodeoxycholic acid

transplant (liver)

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6
Q

define primary sclerosing cholangitis (PSC)

A

autoimmune disease of chronic inflammation of the intra and extra-hepatic bile ducts which leads to bile duct loss

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7
Q

what is PSC associated with?

A

UC

increased risk of cholangiocarcinoma

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8
Q

presentation of PSC

A

asymptomatic

itch, rigors

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9
Q

diagnosis of PSC

A

MRCP/ERCP

LFTS (cholestatic)

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10
Q

management of PSC

A
  • bile flow e.g. stent
  • monitor for cholangiocarcinoma and colorectal carcinoma
  • control of itch
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11
Q

define haemochromatosis

A

storage disease of excess iron in the liver

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12
Q

causes of haemochromatosis

A 
primary= genetics
secondary= overload from diet
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13
Q

presentation of haemochromatosis

A 
MEALS
myocardial: dilated cardiomyopathy and arrhythmias
Endocrine: diabetes
Arthritis 
Liver: cirrhosis and HCC
Skin: grey
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14
Q

diagnosis of haemochromatosis

A

liver biopsy with Perls stain (blue)

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15
Q

management of haemochromatosis

A

phlebotomy: removal of blood stimulates the bone marrow to make new red blood cells using up iron in storage

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16
Q

define Wilson’s disease

A

this is an autosomal recessive disease that leads to abnormal copper metabolism

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17
Q

presentation of Wilson’s disease

A

kayser-fleischer rings at corneal limbus

Parkinson-like symptoms

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18
Q

diagnosis of Wilson’s

A

low serum caeruloplasmin

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19
Q

management of Wilson’s

A

chelating agents e.g. penicillamine

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20
Q

define alpha1 antitrypsin deficiency

A

autosomal recessive disease which produces a lack of this inhibitor causing emphysema and cirrhosis

21
Q

define cholelithiasis

A

this is stone-like material formed within the biliary system, usually due to bilirubin and cholesterol excess or a lack of bile salts (Crohn’s)

22
Q

presentation of cholelithiasis

A
  • asymptomatic
  • biliary colic (RUQ pain radiates to shoulder)
  • itch
  • nausea
    obstruction indicated by pale stools, jaundice and abdominal pain
23
Q

risks of cholelithiasis

A

cholangitis
pancreatitis
gallstone ileus

24
Q

diagnosis of cholelithiasis

A

ultrasonography
US
MRCP/ERCP
LFTs

25
Q

management of cholelithiasis

A

lifestyle
recurrent symptoms then cholecystectomy - 6 -12 weeks to reduce inflammation of the biliary tree or within 72 hours of inflammation
if unfit for surgery then ursodeoxycholic acid

26
Q

define cholecystitis

A

inflammation of the gall bladder

27
Q

presentation of cholecystitis

A

obstructive jaundice
RUQ pain radiating to shoulder
tender abdomen
fever, nausea

28
Q

diagnosis of cholecystitis

A

Murpheys sign (pressure on RUQ pain on inspiration)
bloods - neutrophils
US gall bladder wall is thickened and pericystic fluid

29
Q

management of cholecystitis

A
  • cholecystectomy

- metronidazole

30
Q

define cholangitis

A

inflammation of the biliary tree

31
Q

presentation of cholangitis

A

Charcot’s triad: fever, jaundice and abdominal pain

pruritus

32
Q

diagnosis of cholangitis

A

bloods
abdominal CT with contrast
MRCP
PTC (X-ray with contrast)

33
Q

management of cholangitis

A 
ceftriaxone and metronidazole 
biliary decompression (ERCP with sphincterotomy and stent)
34
Q

what is cholangiocarcinoma associated with?

A

UC

PSC

35
Q

presentation of cholangniocarcinoma

A

obstructive jaundice
weight loss
lethargy

36
Q

diagnosis of cholangiocarcinoma

A

ultrasound
LFTs
ERCP/MRCP

37
Q

management of cholangiocarcinoma

A

liver resection (chemo, embolisation, biliary drainage)
transplant
biliary stent ERCP/PTC (palliation)

38
Q

what causes obstructive jaundice

A 
stones
cancer in pancreas head
PBC
PSC
cholangiocarcinoma
39
Q

presentation of obstructive jaundice

A 
jaundice
dark stools
pale urine
itch
biliary colic
40
Q

diagnosis of obstructive jaundice

A 
bloods
LFTs
ANA or ASMA
MRCP/ERCP
EUS for pancreatic carcinoma
41
Q

what triggers biliary colic?

A

fat entering the digestive system causes CCK (choleystokinin) secretion from the duodenum which triggers contraction of the gall bladder

42
Q

how long for cholecystectomy once cholecystitis has developed?

A

6 -12 weeks later to reduce inflammation of the biliary tree or within 72 hours of inflammation

43
Q

antibiotics in cholecystitis if surgery unfit

A

metronidazole

44
Q

what is post-cholecystectomy syndrome?

A

changes in bowel flow after gall bladder removal causes diarrhoea, indigestion, RUQ pain, nausea, intolerance to fatty food and flatulence

45
Q

commonest organisms for cholangitis

A

e. coli
klebsiella
enterococcus

46
Q

cholangitis- what to use if unsuitable for ERCP

A

PTC (percutaneous trans-hepatic cholangiography)

47
Q

uses of ERCP

A 
visualisation
sphincterotomy
clearing stones
inserting stents
balloon dilatation
taking biopsies
48
Q

complications of ERCP

A

bleeding
cholangitis
pancreatitis

GI: Key Information (24 decks)

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