Billiary tree Flashcards
What is Primary Billiary Cirrhosis
Progressive damage and eventual loss of the bile duct
What causes primary billiary cirrhosis
Fibrosis of the liver causes toxic bile acids to be retained in the liver causing damage to the bile duct
Risk factors of Billiary cirrhosis
Female
45-60
Hx/Fh of autoimmune disease
Signs & Symptoms of primary Billiary cirrhosis
- Increased cholesterol
- Itch
- Dry eyes and mouth
- fatigue
- Postural dizziness
- Jaundice
- Hepatomegaly
- Skin pigmentation
Mangement of primary billiary cirrhosis
- bile acid analogue
- Liver transplant
What Antibodies do you investigate for in primary billiary cirrhosis
- Anti-mitochondrial antibodies
What is cholecystitis
inflammation of the gallbladder
what are the symptoms of cholecystitis
- RUQ
- R shoulder pain
- Murphys sign
- (fever)
- N&V
- Anorexia
What are the risk factors of cholecystitis
- Gallstones
- DM
- TPN
- Severe illness
What is the management of cholecystitis
- supportive
- Oral/IV Abx
- NSAIDs
What would you see on USS in cholecystitis
- Distended GB
- thickened GB wall
- stones
- Pericholecystic fluid
What is gallstone Ileus
when a gallstone moves out of the GB into the billiary tree and drops into the duodenum causing an obstruction of the bowl
What is Mirrizi’s Syndrome
Common hepatic duct obstruction due to extrinsic compression of a gallstone in the cystic duct
What is cholelithiasis
Gallstones: solid particles that form from bile cholesterol and bilirubin in the gallbladder
What are the risk factors for gallstones
- Drugs
- Pregnancy
- FH
- TPN
- DM
- Fat
- AGe
- NAFLD
What are the symptoms of gallstonse
Post prandial RUQ pain - cramping
what investigation should e done for suspected gallstones
- USS
- Bloods - normal
- MRCP
- Lipase/amylase
What are the differentials for gallstones
- acute pancreatitis
- hepatic abscess
- peptic ulcer disease
- Perforation
- pyelonephritis
- ## Lower lobe pneumonia
What is ascending cholangitis
Inflammation of the bile duct, usually from bacteria ascending the biliary tree from the duodenum. Usuualy occurs when bile duct already compacted with gallstones
What are the risk factors for ascending cholangitis
- > 50
- gallstones
- Hx of sclerosing cholangitis
- stricture: benign or malginant
what are the symptoms of ascending cholangitis
- Jaundice
- fever
- RUQ
- hypotension
- puritis
- clay coloured stool
What might you see in the bloods of someone with ascending cholangitis
- raised WBC
- raised CRP
- Decreased platelet- raised urea and createnine
What LFT and Coag results would you expect to see in someone with ascending cholangitis
ALP > ALT
raised billirubin
increased PTT
What ABG result might you obtain in someone with ascending cholangitis
- metabolic acidosos
- low HCO3
- raised lactate
What might you see on the USS of someone with ascending cholangitis
dialted bile duct
gallstones
What is the management of ascending cholangitis
- IV ABx
- ERCP - billiary decompression
- Opiods
- Lithotropy
- Elective cholecystectomy
What are the complications of ascending cholangitis
- Perforation
- Acute - hepatic abscess
- bile duct injury during surgery
- gangrenous cholecystitis
What are the symptoms of acute pancreatitis
- Epigastric pain radiating to back
- anorexia
- Hypovolaemia
- Grey turners sign
- Cullens sign
What blood investigations should you complete for suspected acute pancreatitis
- FBC, CRP, U&E, LFTs
- Lipase/amylase
- haematocrit if suspecting necrosis
- ABG
What imaging should you complete for suspected acute pancreatitis
- MRCP
- Abdo film
- US
- +/- CT
What are the complications of acute pancreatitis
- Sepsis
- Necrosis
- Acute lung injury
- Acute renal failure
- Pseudocyst - esp. if alcoholic
- retroperitoneal bleeding
What is the management fo acute pancreatitis
- IV fluids
- O2
- Pain relief
- anti-emetic
- Ca/Mg replacement
- May require insulin or Abx
- nutrition support
What are the risk factors for chronic pancreatitis
- Alcohol
- Smoking
- FH
- Coeliac
What are the symptoms of chronic pancreatitis
- Jaundice
- N&V
- Steatorrhoea
- Malnutrition/weight loss
- abdo pain
What are the investigations for chronic pancreatitis
- Blood glucose
- Abdo Us
- Abdo Xray
- CT
What is the management of chronic pancreatitis
- stop smoking/drinking
- pain relief
- May require pancreatic enzymes
What are the complications of chronic pancreatitis
- DM
- Duct obstruction
- Opiod obstruction
- low trauma #
- pseudocyst
- exocrine insufficienct
- calcification
What are the main causes of pancreatitis
G: Gall stones E: ethanol T: Trauma S: steroids M: Mumps A: Autoimmune S: scorpion H: hyper Ca/triglycerides E: ERCP D: Drugs
What drugs are known to cause pancreatitis
azathioprine
diuretic - furesomide
What are the RF of pancreatic cancer
- FH
- SMoking
What are the signs and symptoms of pancreatic cancer
- Jaundice
- Non-specific abdo pain
- weight loss/anorexia
- steatorrhoea
- N&V
What investigations should be carried out if suspecting pancreatic cancer
- LFTs
- CT
- Abdo USS
What is the management of pancreatic cancer
- Surgery
- Neoadjuvant radiotherapy
- Enzyme replacement
- Post op stenting
