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ARP 2 > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

What are the three types of clinical indications of a hepatobilliary pathology?

A

Unexplained – weight loss – pain – right upper quadrant

Gallstones > Blockages/obstruction - severe illness + jaundice

Tumours - Pancreas + duodenum > prevent flow of bile to the duodenum

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2
Q

What is cholecysitis?

A

Inflammation of gallbladder - painful RUQ

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3
Q

What is the cause of cholecysitis?

A

Gallstones

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4
Q

What is the treatment of cholecysitis?

A

Pain relief – antibiotics – fluids

The gallbladder can be removed to prevent further attacks (laparoscopic cholecystectomy)

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5
Q

How are gallstones formed and what are they made of?

A

Substances reach the limit of solubility – mix with bile sludge – Stone is formed

The two main substances – cholesterol + calcium bilirubinate

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6
Q

What is the most common cause of digestive disease?

A

Gallstones

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7
Q

What is the incidence m v. w of gallstones?

A

Women are 2 to 3 times more likely than men during their reproductive years

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8
Q

What are the risk factors for gallstones?

A

Being over 40 to 60

Pregnancy

overweight or obese

sedentary lifestyle

high sat fat diet

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9
Q

 what colour are the different stones in relation to their composition?

A

Cholesterol stones – yellow

Calcium, Bilirubin + pigment gallstones – black/brown

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10
Q

What are the signs and symptoms of gallstones?

A

Biliary colic/RUQ pain

Attacks occur after eating – especially high saturation meals

Intense pain behind shoulder

Possible vomiting

jaundice due to non excretion of bilirubin

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11
Q

What are the complications of gallstones?

A

Blocked duct at ampulla of vatar

Bile may back up into liver – infected

Biliary obstruction – jaundice

Severe pain and inflammation– cholecysitis

Pancreatitis

Start capacitor the duodenum – Balance duction – gallstone Ileus

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12
Q

What is jaundice?

A

Yellowing of skin (eyes) from accumulated Billirubin in the skin – is itchy and uncomfortable

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13
Q

What is obstructive jaundice?

A

Failure of excretion of BilliRubin biliary system

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14
Q

What is the cause of obstructive jaundice?

A

Gallstones

Cancer – especially at head of pancreas – may give rise to jaundice

Lactogenic obstruction usually secondary to surgery

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15
Q

What is the treatment of gallstones?

A

Surgery – Laparoscopic/keyhole – gallbladder is not essential organ for life – cholestectomy

Active monitoring +/- Pain relief

Balance diet – eat well plate

Stones removed by ERCP or PTC

Medication to dissolve stones

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16
Q

What imaging is used for imaging gallstones?

A

X-ray – if the composition has a high calcium

Ultrasound – this is the number one modality

CT

ERCP

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17
Q

What is ERCP and its complications?

A

Endoscopic retrograde cholangiopancreatography

Complications: (gallstone)

Sepsis

Haemorrhage

Perforation – by leak

death

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18
Q

What modalities does the pancreas show up on?

A

CT and MRI

Difficult organ to image with plain radiography

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19
Q

What is pancreatitis?

A

Inflammation of the pancreas, cause by activation of pancreatic enzymes in the pancreas is post to the duodenum

20
Q

What are the clinical indication/symptoms of acute Pancreatitis?

A

 severe abdominal pain

Infection

Internal bleeding

Life threatening

Fever or jaundice

21
Q

What is chronic Pancreatitis?

A

Slow

Insert

Gradual destruction of pancreas

22
Q

What is the cause of chronic pancreatitis
And what can it lead to?

A

Most common alcoholism but could be gallstones
can lead to type two diabetes pancreatic insufficiency and pancreatic cancer

23
Q

What is the aetiology of pancreatitis?

A

75% linked to obesity and alcohol

Alcohol abuse

Trauma to pancreas

Blockage of pancreatic duct

Blockage of common bile duct

Autoimmune response

Increase fat levels in blood



24
Q

Imaging of pancreatitis?

A

Ultrasound to determine gallstones

CT is a choice in the diagnosis and staging of acute pancreatitis and it’s complications

25
Q

 what is the prognosis of pancreatic carcinoma?

A

It’s usually a late diagnosis so a very poor prognosis

26
Q

What are the risk factors of pancreatic carcinoma?

A

Male

Smoking

Age

Chronic pancreatitis

27
Q

What is the treatment of pancreatic carcinoma?

A

Only curable through resection

(5% of all cancer)

28
Q

What is fatty liver?

A

Enlarged liver from fat deposits

Benign

10 to 24% of population

29
Q

What is the cause of a fatty liver

A

Alcohol or metabolic diseases (diabetes are obesity)

30
Q

How is a fatty liver diagnosed?

A

Incidentally through a blood test

CT or MRI or ultrasound can confirm

31
Q

How does a fatty liver present on different imaging modalities?

A

CT – liver darker than Spleen

MRI - fat appears bright on T1 weighted images

US – bright liver

32
Q

What can a fatty liver progress to?

A

Non-alcoholic steatohepatitis (NASH)
- fibrosis + scarring

33
Q

What is cirrhosis?

A

Scarring of the liver

34
Q

What is the cause of cirrhosis?

A

Long-term disease or trauma

35
Q

What is the result of cirrhosis?

A

Reduced liver function did scar tissue

May lead to:
nosebleeds,
ankle oedema,
oesophageal varices,
extra sensitivity to drugs and carcinoma

36
Q

What is the prognosis of carcinoma of the liver?

A

Primary tumours are advanced before a diagnosis – poor prognosis

37
Q

What are the risk factors of carcinoma in the liver?

A

 hepatitis

Cirrhosis

Male

38
Q

Why is Metastatic disease is common in the liver?

A

High blood flow

Primary tumours:

GI, breast, lung, ovarian

39
Q

Imaging of the carcinoma of the liver?

A

Ultrasounds – a mass of over to centimetre has after 9 to 5% chance of Being a hepatocellular carcinoma

Commonly used imaging modalities –

CT

Pet

MRI

ERCP


40
Q

Why is it that liver metastasis most often come from the colon?

A

Due to the portal venous system – linking liver and digestive system

41
Q

Liver metastasis prognosis?

A

Not usually good but treatments are being developed

More common than liver primary tumours

42
Q

What is hepatitis?

A

Inflammation of the liver reducing liver function

43
Q

What is the cause of hepatitis And what can it lead to?

A

Caused by viruses a A B and C

Drug or alcohol abuse

May lead to – cirrhosis are carcinoma

44
Q

What is the treatment for hepatitis?

A

Drugs

45
Q

What are the symptoms for hepatitis?

A

Loss of appetite

Nausea

Vomiting

Pale stools

Dark Urine and pain

ARP 2 (9 decks)

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