Biliary things Flashcards
what is primary biliary cirrhosis vs primary sclerosing cholangitis
PBC = intrahepatic bile ducts damaged by chronic AUTOIMMUNE inflammation causing cholestasis
PSC = destruction of intra- and extrahepatic bile ducts from fibrosis and inflammation
antibodies in PBC
antimitochondrial
symptoms
pt middle aged with fatigue and itching - think PBC!!!
later jaundice, xathelasmata
hepatosplenomegaly
LFT finding PBC
ALK PHOS raised the most
bilirubin raised later in disease.
Liver synthetic function is preserved until late in the disease, so serum albumin and clotting are usually normal
what may occur secondary to PBC
malabsorption of ADEK vitamins
osteoporsis
treatment of PBC
ursodeoxycholic acid (secondary bile acid)
replace fat soluble vitamins
cholestyramine helps itch
major indication for transplant
what may occur late in PBC
can lead to fibrosis, cirrhosis and portal HTN
cause of obstruction PBC vs PSC
what is seen on microscopy?
pbc = granulomatous inflammation. granulomas on microscopy
PSC = fibrosis destroys bile ducts. onion skin fibrosis on microscopy
PBC vs PSC males and females
PBC more common in females
PSC - males
other disease association PBC vs PSC
PBC - other autoimmune disorders e.g. sjogren’s, RA etc
PSC = UC
clinical features PBC vs PSC
PBC = fatigue and pruritus
PSC = progressive obstructive jaundice
complications PBC vs PSC
PBC = cirrhosis
PSC = cirrhosis, cholangiocarcionoma (10% develop it)
antibodies PBC vs PSC
PBC = antimitochondrial antibodies PSC = pANCA
what are stones made of
calcium bilirubinate (pigment stones, caused by excess heamolysis) cholesterol (80% of stones)
can be mixed
complications of stones
biliary colic cholecystitis obstructive jaundic pancreatitis cholangitis (inflammation of bile dut due to infection
which duct is usually blocked in cholecystitis
cystic duct
what duct is usually blocked in cholangitis
common bile duct
location and radiation of pain in biliary colic
epigastic but may be RUQ componenet
radite over right should and right subscapular
ix of biliary colic
USS
symptoms if cholecysitis/cholangitis
fever
rigors
symptoms of biliary colic
pain
n+v
jaundice if CBD
difference in clinical features if cholecystits vs just a stone in the duct
local peritonism
fever
vomiting
raised WCC
is there jaundice in cholecystitis
no as stone blocks cystic duct, not CBD
what is murphy’s sign
place two fingers in RUQ and ask patient to breathe in. causes pain and ARREST of inspiration
treatment of colic
pain killers
stone usually passes on its own
how differentiate colic vs cholecystitis vs ascending cholangitis
colic = just pain cholecystitis = pain + systemic symptoms cholangitis = pain + systemic symptoms + jaundice
organisms that cause ascending cholangitis
gram -ve bacilli - ecoli, enterococcus, anaerobes
5 risk factors for cholelithiasis (stones
fair fat female fertile forty
