Hepatobiliary Flashcards
What are the complications of Acute Cholecystitis ?
Acute pancreatitis, recurrent cholecystitis, jaundice, cholangiocarcinoma
What is Mirizzi syndrome?
Common hepatic duct obstruction caused by extrinsic compression. This is either due to a impacted stone in the cystic duct or in the infundibulum of the gall bladder.
How would a patient with Mirizzi syndrome present (classic 3 symptoms)?
Fever, right upper quadrant pain and jaundice.
What is the primary treatment for Mirizzi syndrome?
Laparoscopic cholecystectomy
Which anti-body is related to primary biliary cirrhosis?
Anti-mitochondrial antibody
What are the 3 signs of Charcot’s Triad?
Jaundice, RUQ pain and Fever
What is charcot’s triad indicative of?
Cholangitis - usually ascending
A patient comes in with Jaundice what are the 5 possible differential diagnosis (big topics) ?
Haemolytic jaundice - dark stools and urine, pallor, splenomegaly with normal LFTs.
- Drugs (sulfasalazine/methyldopa), sickle cell, thalassemia.
Hepatocellular jaundice
- damage to the liver causing trouble in conjugating and excreting bilirubin.
- Cirrhosis, hepatitis, drug induced (halothane, paracetamol)
Cholestatic jaundice
- Biliary obstruction so conjugated but can’t excrete.
- Dark urine and pale stools (lack of sterco bilirubin)
- Primary biliary cirrhosis, primary sclerosing cholangitis, alcohol, drugs, hepatitis, CF, pregnant, post surgery. WILSONS DISEASE.
Familial - Gilberts syndrome, criggler-Najar syndrome
Neonatal - common especially in premature children. Immature glucuronyl transferase and there is rapid foetal RBC breakdown as it is no longer needed.
How is hepatitis A spread and where is it common?
Faecal oral spread. Common in areas of poor sanitation
What is the treatment for hepatitis A and how long does it take?
Supportive - avoid alcohol. Should be resolved in 3-6 weeks. Acute only.
What is raised in hepatitis A?
ALT
HPA - IgM
What type of virus is hepatitis B and is it acute or chronic?
DNA - reverse trasncriptase
Acute
And chronic - especially in younger patients.
What is raised in hepatitis B/
HBsAG (And ALT)
What drugs are used to treat chronic hepatitis B?
Pegylated interferon or nucleoside/nucelotide analogues
How is hepatitis C spread ?
Parenteral - blood (IV drug users) sex or vertical.
What type of virus is hepatitis C and what serotype is most common?
RNA - 1a/1b
What is the usual presentation of hepatitis C?
Asymptomatic and usually presents with chronic liver disease. Or can present after the incubation period with flu
What tests should be completed for hepatitis c?
HCV-RNA, Anti-HCV IgM, USS, AFP, Biopsy (if required)
Is hepatitis curable if so what drugs are used?
Yes
Protease inhibitors and anti-virals.
Sofusbovir + ribavirin + PEG-interferon.
What are the complications of hepatitis C?
Cirrhosis/HCC. Can be fatal
What viruses increase the risk of hepatocellular carcinoma?
Hepatitis B and C - cirrhosis
What is the common cause of hepatitis E?
Drinking contaminated water
What is the main treatment for hepatitis E and how long should it take to clear up?
Supportive - clears up within a few weeks
What is fatty liver disease?
Accumulation of fat inside hepatocytes
What is the pathophysiology of chronic liver disease?
Progressive destruction of the liver for more than 6 months. Fibrosis (scarring) –> cirrhosis (scar tissue)
What are the causes of chronic liver disease?
Non-alcoholic fatty liver disease (DM II, Hypertension, hyperlipidaemia, obesity)
HBV, HCV, HDV
ALCOHOL (fatty liver, hepatitis, cirrhosis)
CF
Haemochromatosis
Wilson’s disease
Autoimmune
Drugs - Isoniazid, methotrexate, amiodarone, phenytoin.
What are the symptoms/signs of chronic liver disease?
Fatigue Encephalopathy (flapping asterix) Hands - dupytrens contracture, palmar erythema, leukonochyia Jaundice Spider naevi, gynaecomastia Caput medusa Ascites Spleno or hepatomegaly
What can be used to score the severity of chronic liver disease?
UKELD
Child-pugh score
What blood tests can be done to diagnose chronic liver disease - determining the cause?
FBC, LFT, coagulation, albumin, PT, platelets, viral screen, iron, ferritin, copper, alpha-1 trypsin
What are the best imaging for chronic liver disease?
USS
CT
- Fatty, nodules or carcinoma
Why would a gastroscopy be done in suspected chronic liver disease?
Oesophageal varices due to portal hypertension.
What are the main complications that can occur from chronic liver disease?
Oesophageal varices HCC Encephalopathy Ascites - SBPeritonitis Hepatorenal syndrome Hyponatremia
What is the treatment for hepatic encephalopathy?
LAxatives to remove the excess ammonium. or enema if that doesn’t work.
Can give metronidazole to prevent the breakdown of nitrogen.
What is Budd Chiari Syndrome?
What is the triad of symptoms?
What is first line investigation for it?
What is the treatment for it?
Blood clot develops in the hepatic vein
Abdominal pain + Ascites + Hepatomegaly
USS with doppler
Anti-coagulation - heparin
