Hepato-Biliary Pathology

Question 1

what is the first appropriate investgation in this 88 y/o man

presentation: 2 days oh epigastric pain, vomiting, abdo distended and jaundice

PMH: jaundice 25 year ago, chronic epigastric pain, glaucoma, cataract removal

Answer 1

LFTs –> Abdo CT

Question 2

A CT shows gall stones, dilated intra and extra-hepatic ducts and a normal pancreas. Next steps

Answer 2

ERCP to remove small stones

Laparotomy to remove further stones

Question 3

what is cholangitis

Answer 3

inflammation of bile duct system usually related to bacterial infection

Question 4

what is a common cause of bacterial cholangitis

Answer 4

gall stones

Question 5

complication of cholangitis secondary to gall stones

Answer 5

infection ascends –> liver infection –> live abscess

Question 6

what enzyme is raised in primary biliary cholangitis

Answer 6

alkaline phosphatase

Question 7

which autoimmune liver disease is associated with IBD

Answer 7

primary sclerosing cholangitis

Question 8

which autoimmune liver disease has an increased risk of cholangiocarcinoma

Answer 8

primary sclerosing cholangitis

Question 9

complications of gall bladder inflammation

Answer 9

empyema
perforation of gall bladder
biliary peritonitis