Hepatobiliary Flashcards
What is cholestasis?
Blockage of the flow of bile
What is cholelithiasis?
Gallstone(s) are present
What is choledocholithiasis?
Gallstone(s) present in the bile duct
What is biliary colic?
Intermittent RUQ pain caused by gallstones irritating the bile ducts
What is cholecystitis?
Inflammation of the gallbladder
What is choleangitis?
Inflammation of the bile ducts
What is a cholecystectomy?
Surgical removal of the gall bladder
What is a cholecystostomy?
Inserting a drain into the gallbladder
What are the risk factors for developing gallstones? (4 Fs)
Female
Forty
Fertile
Fat
What are the features of biliary colic?
Severe, colicky epigastric or RUQ pain
Often triggered by fatty meals
Can be associated with N+V
What can a raised ALP indicate?
Problems with the liver or bone
Biliary obstruction, liver/bone malignancy, primary biliary cirrhosis, Pagets etc.
Can also be raised in pregnancy as placenta releases it
What LFTs are useful markers of hepatocellular injury?
ALT
AST
What would this picture indicate?
Slightly raised ALT and AST
Higher rise in ALP
An obstructive picture in the hepatobiliary system e.g. gallstones
What would this picture indicate?
Raised ALT, AST and ALP?
A problem in the liver itself
What are the complications of ERCP?
Excessive bleeding
Cholangitis
Pancreatitis
What is the treatment of gallstones?
Asymptomatic - conservative, no intervention required
Symptoms or complications - Cholecystectomy
What is acute cholecystitis?
Inflammation of the gallbladder which is caused by a blockage of the cystic duct, preventing the gallbladder from draining
95% of cases are caused by gallstones
What are the features of acute cholecystitis?
RUQ pain
Fever
+ve Murphey’s sign
Occasionally slightly deranged LFTs
Raised inflammatory markers and WBCs
What is murphy’s sign?
Place hand in RUQ and apply pressure
Ask patient to take a deep breath in
Gallbladder moves down with inspiration and comes into contact with hand
Results in acute pain
What is the management of acute cholecystitis?
US to confirm gallstones
Cholecystectomy, ideally within 48 hours of symptoms
What are the features of acute cholangitis?
Charcot’s Triad
- Fever
- RUQ pain
- Jaundice (raised bilirubin)
What are the 2 main causes of acute choleangitis?
Obstruction in the bile ducts stopping bile flow (e.g. gallstones in the bile duct)
Infection induced during an ERCP procedure
What are main causative organisms of ERCP?
E. Coli
Klebsiella species
Enterococcus spieces
What is the management of acute cholecystitis?
Fluid resus
Antibiotics (Amox, Met and Gent)
Early ERCP
PTC where ERCP is not suitable
