Hepatobiliary patho Flashcards
Consequences of liver failure?
ABCDE !
Ammonia - Hepatic encephalopathy -> Asterixis, Confusion
Bile retention - Cholestasis -> Hepatic jaundice
Coagulopathy - Easy bruising
Distension - Ascites (portal HTN -> Splenomegaly / Varices)
Estrogen - Hyperestrogenemia -> Gynecomastia
Similarities between Hep A & E?
AcutE fEcAl !!
Acute hepatitis
Fecal-oral transmission [others BCD all parenteral]
What causes chronic hepatitis?
B & C (&D)
E if immunocompromised
What hepatitis virus has vaccine?
Hep A & hep B
but vax for hep B is protective for hep D (bc HepD only infects those already with HepB infection)
Are hepatitis viruses ssRNA or dsDNA?
All ssRNA except Hep B is dsDNA
Hep C vs Hep B
Hep** C** higher percentage of Carriers
-> Higher risk of Cirrhosis & liver Cancer (hepatocellular carcinoma)
Treatment for hepatitis?
Hep C : antiviral agents
Hep B : prophylactic vaccination against Hep A
others : NA, mostly recovers spontaneously
Serology diagnosis for hepatitis?
Hep A : Anti-HAV IgM
Hep B : HBsAg, anti-HBcAg IgM
Hep C : Anti-HCV IgG, RT-PCR
Hep D : Anti-Delta
Hep E : Anti-HEV IgM, IgG, RT-PCR
RT-PCR : presence of RNA = confirm current infection, not past
What causes colicky pain worse with fatty food?
Biliary colic
Cholelithiasis (GB stone)
What gives positive Murphy’s sign? (RUQ pain on palpation + during inspiration)
Cholecystitis (GB cystic duct inflammation)
- fever & leukocytosis too (inflammation)
What BT patho causes obstructive jaundice?
Choledocholithiasis (CBD stone)
Cholangitis (bile ducts inflammation)
What gives positive Charcot’s triad? [RUQ + Jaundice + Fever]
Cholangitis
Autoimmune cholangiopathies :
Difference between Primary sclerosing cholangitis (PSC) & Primary biliary cholangitis (PBC) ?
PSC : Intrahepatic & Extrahepatic.
- IBD
PBC : Intrahepatic ducts only.
- Sjogren’s syndrome
- AMA+
- non-caseating granulomas
Cholangitis vs Cholecystitis?
Cholangitis
- inflammation of BT
- due to choledocholithiasis
- obstruction -> jaundice
- Charcot’s triad : obstructive jaundice + RUQ pain + fever
Cholecystitis
- inflammation of GB
- due to cholelithiasis
- bile can still flow -> unlikely to have jaundice
- Murphy’s sign : Right subcostal pain on palpation, during inspiration
What leads to pale stools & tea-coloured urine?
Obstructive jaundice
Hepatitis / BT obstruction
How does head of pancreas cancer present?
Painless progressive jaundice due to obstruction of common bile duct
How does pancreatitis present?
Acute, severe epigastric pain
Radiate to the back (bc retroperitoneal)
Nausea, vomitting
pain better if lean forward
Which hepatitis worst for pregnant women?
Hep E.
Transplacental transmission of HEV in the third trimester of pregnancy
