Hepatobiliary Flashcards
What are the three types of clinical indications of a hepatobilliary pathology?
Unexplained – weight loss – pain – right upper quadrant
Gallstones > Blockages/obstruction - severe illness + jaundice
Tumours - Pancreas + duodenum > prevent flow of bile to the duodenum
What is cholecysitis?
Inflammation of gallbladder - painful RUQ
What is the cause of cholecysitis?
Gallstones
What is the treatment of cholecysitis?
Pain relief – antibiotics – fluids
The gallbladder can be removed to prevent further attacks (laparoscopic cholecystectomy)
How are gallstones formed and what are they made of?
Substances reach the limit of solubility – mix with bile sludge – Stone is formed
The two main substances – cholesterol + calcium bilirubinate
What is the most common cause of digestive disease?
Gallstones
What is the incidence m v. w of gallstones?
Women are 2 to 3 times more likely than men during their reproductive years
What are the risk factors for gallstones?
Being over 40 to 60
Pregnancy
overweight or obese
sedentary lifestyle
high sat fat diet
 what colour are the different stones in relation to their composition?
Cholesterol stones – yellow
Calcium, Bilirubin + pigment gallstones – black/brown
What are the signs and symptoms of gallstones?
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
What are the complications of gallstones?
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
What is jaundice?
Yellowing of skin (eyes) from accumulated Billirubin in the skin – is itchy and uncomfortable
What is obstructive jaundice?
Failure of excretion of BilliRubin biliary system
What is the cause of obstructive jaundice?
Gallstones
Cancer – especially at head of pancreas – may give rise to jaundice
Lactogenic obstruction usually secondary to surgery
What is the treatment of gallstones?
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
What imaging is used for imaging gallstones?
X-ray – if the composition has a high calcium
Ultrasound – this is the number one modality
CT
ERCP
What is ERCP and its complications?
Endoscopic retrograde cholangiopancreatography
Complications: (gallstone)
Sepsis
Haemorrhage
Perforation – by leak
death
What modalities does the pancreas show up on?
CT and MRI
Difficult organ to image with plain radiography
What is pancreatitis?
Inflammation of the pancreas, cause by activation of pancreatic enzymes in the pancreas is post to the duodenum
What are the clinical indication/symptoms of acute Pancreatitis?
 severe abdominal pain
Infection
Internal bleeding
Life threatening
Fever or jaundice
What is chronic Pancreatitis?
Slow
Insert
Gradual destruction of pancreas
What is the cause of chronic pancreatitis
And what can it lead to?
Most common alcoholism but could be gallstones
can lead to type two diabetes pancreatic insufficiency and pancreatic cancer
What is the aetiology of pancreatitis?
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

Imaging of pancreatitis?
Ultrasound to determine gallstones
CT is a choice in the diagnosis and staging of acute pancreatitis and it’s complications
 what is the prognosis of pancreatic carcinoma?
It’s usually a late diagnosis so a very poor prognosis
What are the risk factors of pancreatic carcinoma?
Male
Smoking
Age
Chronic pancreatitis
What is the treatment of pancreatic carcinoma?
Only curable through resection
(5% of all cancer)
What is fatty liver?
Enlarged liver from fat deposits
Benign
10 to 24% of population
What is the cause of a fatty liver
Alcohol or metabolic diseases (diabetes are obesity)
How is a fatty liver diagnosed?
Incidentally through a blood test
CT or MRI or ultrasound can confirm
How does a fatty liver present on different imaging modalities?
CT – liver darker than Spleen
MRI - fat appears bright on T1 weighted images
US – bright liver
What can a fatty liver progress to?
Non-alcoholic steatohepatitis (NASH)
- fibrosis + scarring
What is cirrhosis?
Scarring of the liver
What is the cause of cirrhosis?
Long-term disease or trauma
What is the result of cirrhosis?
Reduced liver function did scar tissue
May lead to:
nosebleeds,
ankle oedema,
oesophageal varices,
extra sensitivity to drugs and carcinoma
What is the prognosis of carcinoma of the liver?
Primary tumours are advanced before a diagnosis – poor prognosis
What are the risk factors of carcinoma in the liver?
 hepatitis
Cirrhosis
Male
Why is Metastatic disease is common in the liver?
High blood flow
Primary tumours:
GI, breast, lung, ovarian
Imaging of the carcinoma of the liver?
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

Why is it that liver metastasis most often come from the colon?
Due to the portal venous system – linking liver and digestive system
Liver metastasis prognosis?
Not usually good but treatments are being developed
More common than liver primary tumours
What is hepatitis?
Inflammation of the liver reducing liver function
What is the cause of hepatitis And what can it lead to?
Caused by viruses a A B and C
Drug or alcohol abuse
May lead to – cirrhosis are carcinoma
What is the treatment for hepatitis?
Drugs
What are the symptoms for hepatitis?
Loss of appetite
Nausea
Vomiting
Pale stools
Dark Urine and pain
