Hepatobiliary Problems

Question 1

Typical location of pain for biliary colic

Answer 1

Right upper quadrant

Question 2

Typical location of pain for acute cholecystitis?

Answer 2

Right upper quadrant

Question 3

Typical location of pain for ascending cholangitis

Answer 3

Right upper quadrant

Question 4

Typical location of pain for acute pancreatitis

Answer 4

Epigastrium, sometimes radiating through to the back

Question 5

Caused by a gallstone getting lodged in the bile duct

Classically provoked by eating a fatty meal

In contrast to acute cholecystitis no fever and inflammatory markers are normal

Answer 5

Biliary colic

Question 6

Inflammation/infection of the gallbladder secondary to impacted gallstones

Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)

Fever and raised inflammatory markers

Answer 6

Acute cholecystitis

Question 7

It is a bacterial infection of the biliary tree. The most common predisposing factor is gallstones.

Charcot’s triad of right upper quadrant pain, fever and jaundice occurs in about 20-50% of patients

Answer 7

Ascending cholangitis

Question 8

Usually due to alcohol or gallstones

Pain is often very severe. Examination may reveal tenderness, ileus and low-grade fever

Answer 8

Acute pancreatitis

Question 9

Ascending cholangitis main signs/symptoms

Answer 9

Constant RUQ pain, fever, jaundice, raised inflammatory markers, history of gallstones

Question 10

Acute cholesystisis main signs/symptoms

Answer 10

• Constant RUQ pain, gallstones, pyrexial, raised inflammatory markers (WBCs), rebound tenderness (peritonitis)
• Positive Murphy sign - palpation of the RUQ arrests respiration

Question 11

What’s is a cholecystectomy?

Answer 11

Surgical removal of the gall bladder

Question 12

Gallstone risk factors

Answer 12

4 F’s

• female
• fat (obesity)
• fertile (pregnancy)
• forty (age)

Question 13

In biliary colic, if the gall stone doesnt dislodge itself what does this turn into?

Answer 13

Acute cholecystitis (inflammation of gallbladder)

Question 14

Biliary colic main signs/symptoms

Answer 14

• intermittent RUQ pain after eating large/fatty meals (sometimes radiating to the intrerscapular region), apyrexial (normal temperature), not jaundiced
• Inflammatory markers normal

Question 15

Primary sclerosing Cholangitis main signs/symptoms

Answer 15

• Ulcerative colitis, fatigue, jaundice (increased conjugated bilirubin in blood) and pruritus (itch) and RUQ pain
• raised inflammatory markers (IgM, ALP, GGT)
• decrease urobilinogin in urine and increased bilirubin (bilirubinuria)

Question 16

Complications of primary sclerosing cholangitis

Answer 16

Liver:

• Hepatosplenomegaly - intrahepatic bile ducts fibrosis > increases pressure on portal vein > liver hypertension > fluid build up in spleen and liver&raquo_space; hepatosplenomegaly
• Cirrhosis

Bile duct:

• increased risk of Cholangiocarcinoma

Question 17

What is Primary biliary cholangitis/cirrhosis?

Answer 17

Autoimmune disease

Question 18

What other autoimmune diseases is Primary biliary cholangitis/cirrhosis associated with?

Answer 18

• autoimmune hepatitis
• Sjogrens syndrome

Question 19

Primary biliary cholangitis/cirrhosis main signs/symptoms

Answer 19

• Middles aged female, fatigue, pruritus (itch), raised IgM, ALP (Alkaline phosphate levels) and GGT, jaundice, Xanthomas, joint pain & arthropathy
  
  • Anti-mitrochondrial antibodies (AMAs)