Hepatobiliary Problems Flashcards
What is biliary colic?
Sudden, severe abdominal pain felt in the epigastric region. The pain is intermittent and can be brought on by eating fatty foods.
What is acute cholecystitis?
Inflammation of the gallbladder
What is ascending cholangitis?
Inflammation of the biliary tree causing RUQ pain, fever and jaundice (Charcot’s triad) and potentially hypotension and confusion (Reynaud pentad)
How is acute cholecystitis treated?
IV antibiotics and laparoscopic cholecystectomy within 1 week of diagnosis
How is ascending cholecystitis treated?
IV antibiotics, ERCP and fluids
Give 5 risk factors for developing gallstones
Obesity Female Over 40 COPD Cirrhosis Crohn's disease IBS Family history Weight loss Ceftriaxone
What is Murphy’s sign?
Pressing down on the right hypochondrium and asking the patient to breath in. The gallbladder becomes exposed and the hand touches it so the patient feels pain. Positive in acute cholecystitis
What size does a gallstone need to be to pass naturally?
<5mm
Give 2 conservative ways to manage gallstones
Avoid fatty foods
Eat a healthy diet
Stop smoking
Avoid alcohol
How are gallstones managed medically?
Ursodeoxycholic acid
Pain killers
How are gallstones managed surgically?
Laparoscopic cholecystectomy
ERCP
Give 4 risks of ERCP
Bleeding
Duodenal perforation
Pancreatitis
Cholangitis
What is porcelain gallbladder?
Calcium deposits build up on the inside of the gallbladder usually after recurring inflammation of the gallbladder.
What is Courvoisier’s law?
Jaundice with a painless, palpable gallbladder is unlikely to be gallstones
What is the most common type of gallbladder cancer?
Adenocarcinomas
Give 4 symptoms of gallbladder cancer
Abdominal pain Nausea Jaundice Distended abdomen Weight loss Loss of appetite
Give 4 risk factors for developing gallbladder cancer
Obesity Smoking Unhealthy diet Gallstones Cholecystitis Diabetes Family history Porcelain gallbladder
What is gallstone ileus?
Fistula forms between the gallbladder and the bowel and large gallstones can exit the gallbladder and block the bowel. Needs urgent treatment due to risk of bowel perforation
Give 6 causes of acute pancreatitis
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia ERCP Drugs
Give 3 drugs which can cause pancreatitis
Azathioprine Thiazide Sulfasalazine Trimethoprim Tetracycline Sodium valproate
Give 4 symptoms of acute pancreatitis
Severe, dull epigastric pain worse on eating and drinking and radiating to the back Nausea Diarrhoea Indigestion Fever Jaundice
What are the factors involved in the GLASGOW score for pancreatitis?
PaO2 (<8 kPa) Age (>55 years) Neutrophils (>15 x 10^9/L) Calcium (<2 mmol/L) Renal function (urea >16mmol/L) Enzymes (LDH >600 or AST >2000) Albumin (<32g/L) Sugar (glucose >10mmol/L)
How is acute pancreatitis managed?
Treat underlying cause
Fluids
Oxygen
Analgesia
Give 4 potential complications of acute pancreatitis
Chronic pancreatitis
Sepsis
Infected pancreatic necrosis
Pseudocysts
Give 4 symptoms of chronic pancreatitis
Abdominal pain radiating to the back Worse 15-20 minutes after eating Greasy, foul-smelling stools Nausea Vomiting Weight loss Loss of appetite Jaundice Symptoms of diabetes
Give 3 causes of chronic pancreatitis
Excessive alcohol Autoimmune pancreatitis Trauma Smoking Radiotherapy side effect
How is chronic pancreatitis diagnosed?
Stool sample (fecal elastase) Ultrasound CT scan MRCP X-ray (can see calcification of pancreas)
How is chronic pancreatitis treated?
Avoid alcohol Stop smoking Low fat diet Enzyme supplements Corticosteroids Pain relief
Where in the pancreas does a cancer normally affect?
Head of the pancreas
Why is the prognosis for pancreatic cancer so poor?
Diagnosed late due to vague symptoms and ability for the cancer to grow into the space without consequence
Give 3 risk factors for developing pancreatic cancer
Smoking Alcohol Previous cancer Diet Previous radiotherapy Obesity Old age MEN BRCA2 gene
Give 3 causes of pancreatic cancer
Chronic pancreatitis
Stomach ulcer
H. pylori
Hepatitis
Give 3 symptoms of pancreatic cancer
Dull epigastric pain radiating to the back Worse when lying down Jaundice Weight loss Symptoms of diabetes Itching Nausea and vomiting Steatorrhoea Fever Indigestion
How is pancreatic cancer diagnosed?
USS and CT
How is pancreatic cancer treated?
Chemotherapy
Surgery –> total pancreatectomy, Whipple’s procedure
What is liver cirrhosis?
Chronic scarring of the liver which prevents the liver from functioning normally
Give 4 symptoms of liver cirrhosis
Fatigue, nausea, loss of appetite, loss of sex drive, jaundice, haematemesis, itchy skin, melaena, bruising, oedema, ascites
Give 4 signs of liver cirrhosis
Leukonychia Clubbing Palmar erythema Spider naevi Gynaecomastia Loss of body hair
Give 3 causes of liver cirrhosis
Alcohol excess
Hepatitis
Non alcoholic fatty liver disease
How is liver cirrhosis treated?
Stop drinking alcohol, treat hepatitis, treat cause
Cholestyramine, interferon alpha, spironolactone
Liver transplant
What 5 factors does the Child-Pugh score take into consideration?
Serum bilirubin Serum albumin Presence of ascites Encephalopathy INR
