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GI > biliary tree > Flashcards

biliary tree Flashcards

1
Q

primary biliary cholangitis

A

autoimmune condition where T cells attack small bile ducts in the liver causing bile to leak into the interstitium
chronic inflammation of the bile ducts
progressive destruction of the small bile ducts leads onto cirrhosis

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2
Q

who gets primary biliary cholangitis

A

women in 40-50s

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3
Q

primary biliary cholangitis associated disease

A

sjogren’s
rheumatoid arthritis
hypothyroidism

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4
Q

primary biliary cholangitis signs and symptoms

A 
jaundice
xanthoma
xanthelasma
pruritus
joint pain
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5
Q

primary biliary cholangitis investigations

A 
ant-Mt antibodies
high cholesterol
high GGT and other LFT abnormalitis
high IgM
USS - used to rule out structural abnormalities
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6
Q

primary biliary cholangitis complications

A 
osteoporosis
portal hypertension 
ascites
vitamin deficiencies ADEK
cirrhosis
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7
Q

primary biliary cholangitis management

A

lifestyle
ursodeoxycholic acid - helps delay liver damage, improves bilirubin, aminotransferase levels
obeticholic acid - improves bile flow, reduces inflammation
vitamin ADEK
anti-pruritics
bisphosphonates
liver transplant

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8
Q

primary biliary cholangitis prognosis

A

very variable management only slows progression of cirrhosis

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9
Q

primary sclerosing cholangitis

A

autoimmune condition that causes that progressive inflammation and fibrosis of the bile duct

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10
Q

primary sclerosing cholangitis cause

A

unknown
combination between environmental triggers
genetic susceptibility
increased immunological response to stimulus
associated with UC

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11
Q

primary sclerosing cholangitis symptoms

A

asymptomatic
pruitus - itch
jaundice
RUQ pain

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12
Q

primary sclerosing cholangitis investigations

A 
liver biochemistry - ALP
examination - jaundice, weight loss
ultrasound 
MRCP - beaded appearance from strictures
ERCP
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13
Q

primary sclerosing cholangitis management

A

liver transplant
manage symptoms
good diet and nutrition
endoscopic investigations - preventing progression and obstruction, stenting, balloon dilation

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14
Q

primary sclerosing cholangitis progression

A

secondary biliary cirrhosis - prolonged obstruction of large bile duct can lead to liver cirrhosis
gallstones, strictures and duct cannulation
cholangiocarcinoma

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15
Q

types of gallstones

A

cholesterol - majority
pigmented - bilirubin
brown stones - associated with parasitic infection

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16
Q

cholelithiasis

A

gallstones

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17
Q

cholecystolithiasis

A

gallstone in gallbladder

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18
Q

choledocholithiasis

A

gallstone in bile duct

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19
Q

3 factors precipitating cholesterol gallstone formation

A

cholesterol supersaturation
not enough salt/acid/phospholipid
gallbladder stasis

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20
Q

risk factors for cholesterol stone formation

A 
obesity 
rapid weight loss
diet - high fat, low fibre
family history
female 
increased age 
HRT
fair, fat, fertile, female, forty
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21
Q

biliary colic

A

temporary obstruction of the cystic/common bile duct by a gallstone
may last 2-6 hours

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22
Q

biliary colic signs and symptoms

A

RUQ epigastric colicky pain - right shoulder
associated with indigestion and over indulgence with high fat foods
mid-evening/early morning
nausea and vomiting

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23
Q

biliary colic investigations

A

clinical diagnosis

USS

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24
Q

biliary colic management

A

lifestyle modification
mild-moderation pain - paracetamol NSAIDs
severe pain - diclofenac IM

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25
Q

cholecystitis

A

when obstruction of the cystic duct causes inflammation of the gallbladder
also calculous cholecystitis

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26
Q

cholecystitis signs and symptoms

A 
similar biliary colic 
fever 
RUQ pain 
Murphy's sign - pain on taking deep breath when examiner's fingers are over RUQ at costal margin 
obstructive jaundice
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27
Q

cholecystitis complications

A

perforation
fistula formation
peritonitis
sepsis

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28
Q

cholecystitis investigations

A

high ALP
abdominal USS
MRCP
ERCP

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29
Q

cholecystitis management

A

supportive - fluids, analgesia, IV antibiotics
ERCP
cholecystectomy
percutaneous cholecystostomy - to drain pus

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30
Q

acalculous cholecystitis

A

inflammation of the gallbladder in the absence of a gallstone
associated with higher rates if morbidity and mortality than calculous cholecystitis
more common in very ill patients
gallbladder stasis and bile stagnation

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31
Q

acalculous cholecystitis signs and symptoms

A

same as calculous cholecystitis

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32
Q

acalculous cholecystitis investigation

A

raised ALP
high CRP
USS - thickened gallbladder wall with absence of stones

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33
Q

acalculous cholecystitis management

A

cholecystectomy

percutaneous cholecystostomy

34
Q

ascending cholangitis

A

a bacterial infection superimposed on an obstruction of the biliary tree due to stagnation of bile
obstruction increases the pressure in the bile ducts, widening the spaces between the cholangiocytes. this allows the contaminated bile access to the bloodstream

35
Q

ascending cholangitis complications

A

sepsis

36
Q

ascending cholangitis signs and symptoms

A

Charcot’s triad - fever, jaundice, RUQ pain

Reynold’s pentad - fever, jaundice, RUQ pain, hypotension, confusion

37
Q

ascending cholangitis investigations

A 
bloods - raised WCC, raised CRP
LFTs - raised ALP, bilirubin, GGT
blood culture
USS
MRCP
ERCP
38
Q

ascending cholangitis management

A

IV fluids
antibiotics
remove obstruction via ERCP
cholecystectomy

39
Q

gallstone ileus

A

bowel obstruction caused buy a gallstone within the lumen of small bowel
repeated inflammation can cause thinning of gallbladder wall, fistula forms, between gallbladder and duodenum
small stones pass through bowel and out the stool
large stones get stuck causing mechanical bowel obstruction

40
Q

gallstone ileus signs and symptoms

A

abdomenal distension
nausea and vomiting
recurrent RUQ pain - chronic cholecystitis
dehydration

41
Q

gallstone ileus investigations

A

rigler’s triad - pneumobilia, evidence of small bowel obstruction, gallstone outside of gallbladder

42
Q

gallstone ileus management

A

IV fluid resuscitation
NG tube
gallstone removal

43
Q

biliary strictures

A

a narrowing of the bile duct
benign or malignant
bengn causes - post-op injury, pancreatitis, PSC

44
Q

biliary strictures complications

A

asymptomatic
biliary colic
cholangitis
obstructive jaundice

45
Q

biliary strictures investigations

A

related to cause, need to rule out malignancy

46
Q

biliary strictures management

A

treat cause

stenting

47
Q

congenital biliary atresia

A

babies born with, abscence or deficiency of extra-hepatic biliary tree
leads to cholestasis and liver cirrhosis from back pressure of bile

48
Q

congenital biliary atresia symptoms

A

3 months of birth
jaundice
dark urine, pale stool]growth and development delay

49
Q

congenital biliary atresia investigations

A

blood tests - LFTs, bilirubin
US - fibrous tissue, changes to hepatic blood flow
HIDA scan

50
Q

congenital biliary atresia management

A

excision of fibrous tissue

liver transplant

51
Q

cholangiocarcinoma

A

cancer in the bile duct
intra hepatic (less common) or extra hepatic
bad prognosis due to late detection
hilar cholangiocarcinoma most common tumour where left and right bile ducts join together

52
Q

cholangiocarcinoma risk factors

A

over 65s
SE Asia
previous biliary disease - PSC, gallstones and cysts
genetic predisposition

53
Q

cholangiocarcinoma symptoms

A 
aysmptomatic 
jaundice - dark urine, pale stool 
abdominal pain
weight loss, fatigue, loss of appetite
symptoms of cholangitis
54
Q

cholangiocarcinoma investigations

A

LFTs abnormal bilirubin and marked elevation of ALP and GGT
contrast MRI
CT - staging and metastases
ERCP

55
Q

cholangiocarcinoma management

A

surgical resection
stenting
adjuvant chemotherapy and radiotherapy

56
Q

carcinoma of ampulla of vater

A

a rare cancer that forms at the junction of the common bile duct and the main pancreatic duct
bad prognosis due to invasion of important structures
similar to cholangiocarcinoma
extensive surgery

57
Q

acute pancreatitis

A

inflammation of the pancreas leading to autodigestio

most common causes - gallstones, alcohol, systemic disease, trauma

58
Q

acute pancreatitis causes

A 
idiopathic 
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion bite
hypercalcaemia. hyperthyroidism, hyperlipidaemia
ERCP
drugs - azathioprine, antibiotics, oestrogen
59
Q

acute pancreatitis categorisation

A

mild - absence of complications, uneventful recovery
moderately severe - local complications +/- transient organ dysfunction, resolves within 48 hours
severe - persistent organ dysfunction, local complications

60
Q

acute pancreatitis pathogenesis

A 
due to premature activation of zymogen granules - releases proteases - autodigest pancreas
4 stages 
oedema and fluid shifts
autodigestion of blood vessels
infarction due to comprise blood supply 
necrotic tissue becomes infected
61
Q

acute pancreatitis complications

A

systemic - SIRS, multiorgan dysfunction, hypovalaemic shock
kidney - AKI
pancreas - fluid collection, necrosis, pseudocyst, abscess
lungs - pleural effusion, ARDS
heart - carditis
GI - paralytic ileus, bleeding
metabolic - hypocalcaemia, hypo/hyperglycemia

62
Q

acute pancreatitis signs and symptoms

A

acute, severe epigastric pain, may radiate to back
pain my be alleviated in foetal position/when leaning forward
pain by be associated with meals/excessive alcohol
nausea and vomiting
jaundice
fever
tachycardia
anorexia
abdomen tenderness in epigastric region
abdomen distention
Cullen’s sign - superficial oedema and bruising, peri-umbilical
Grey Turner’s sign - bruising of flank

63
Q

acute pancreatitis investigation

A

high amylase
high lipase
high CRP
imaging - CXR, USS, CT

64
Q

Glasgow prognostic criteria acute pancreatitis

A 
PaO2 <8kPa/60mmHg
Age >55
Neutrophils
Calcium < 2 mmol/l
Renal function (urea>16mmol/l)
enzymes AST/ALT
Albumin <32g/l
sugar (glucose>10mmol/l)
65
Q

acute pancreatitis management

A 
IV fluid resuscitation 
O2 therapy 
pain relief 
nutritional support through enteral feeding
antibiotics 
gallstones -ERCP/cholecystectomy 
alcohol advice 
treat compklicatioons
66
Q

chronic pancreatitis

A

progressive and irreversible

will lose exocrine function and sometimes endocrine function

67
Q

chronic pancreatitis pathogenesis

A

unclear, many theories
may be due to the premature activation of enzymes or impaired clearance of enzymes - trypsin
alcohol though to increase trypsin activation

68
Q

chronic pancreatitis casues

A 
alcohol 
idiopathic
pancreatic duct obstruction 
autoimmune
tropical countries 
alpha1-antitrypsin 
CF
69
Q

chronic pancreatitis history

A

similar to acute pancreatitis - flare ups
epigastric pain, radiating back, nausea, vomiting
jaundice, itching, ascites, masses
alcohol intake, smoking
medication - antibiotics, steroids, ACEI

70
Q

chronic pancreatitis investigations

A 
blood tests - LFTs
CXR and abdominal x-ray
CT pancreas
MRI
USS 
ERCP
71
Q

chronic pancreatitis management

A

manage acute phase
lifestyle - pain management, screen for other diseases
Creon - replacement pancreatic enzymes
surgery - Pustow’s or Frey’s procedure

72
Q

pseudocysts

A

a collection of fluid that forms in the pancreas

sac is not lined by epithelial cells

73
Q

pseudocysts causes

A 
trauma 
idiopathic
pancreatico-duodenal communication following surgery
biliary obstruction 
gastruc outlet obstruction
complication of acute pancreatitis
74
Q

pseudocysts treatment

A

drained or resected in surgery

75
Q

pancreatic tumours

A

95% adenocarcinoma in exocrine component

majority form in head or neck of the pancreas

76
Q

pancreatic tumour risks

A 
increasing age
male 
smoking 
alcohol 
diabetes 
chronic pancreatitis
77
Q

pancreatic tumour symptoms

A 
painless jaundice 
weight loss
back pain
fatigue, nause, vomiting 
malbsorption
78
Q

Courvoisier’s sign

A

palpable non-tender gallbladder, painless jaundice
biliary obstruction
most likely head of pancreas tumour

79
Q

pancreatic tumour investigations

A 
blood tests 
US
triple phase CT
MRI
MRCP
80
Q

pancreatic tumour management

A

chemotherapy
radiotherapy
possibly surgery

GI (10 decks)

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