Heptaobiliary Disease

Question 1

HBsAg

Answer 1

acute/chronic infection

Question 2

HbEg

Answer 2

high degree of hbv infectivity and viral replication

Question 3

Anti HBs

Answer 3

marker of previous infection/vaccination

Question 4

Anti HBe

Answer 4

lower viral titre and infectivity in chronic hep b

Question 5

anti HBc IgG

Answer 5

non specific marker of current/previous infection

Question 6

Anti HBe IgM

Answer 6

infection with HBV in last 6 months

Question 7

Gilbert’s

Answer 7

reassurance, prevent unecessary investigation

Question 8

Autoimmune hepatitis

Answer 8

prednisolone 2-3 weeks
maintenance dose of 10-15mg
Azothioprine continued lifelong

Question 9

Hep B

Answer 9

stop alcohol, supportive
Chronic: remove HBeAg and HBV DNA from serum
by using alpha interferon, subcut
lamivudine oral 1 year
adefovir oral 1 year

Question 10

Hep C

Answer 10

watchful waiting if mild, chronic

PEG interferon alpha2 and ribavarin

Question 11

pyogenic liver abcess

Answer 11

aspiration under USS guidance
broad spectrum abx
further drainage w/wide bore needle
treat underlying cause

Question 12

Amoebic liver abcess

Answer 12

metronidazole PO 5 days
diloxanide furate
aspirate if no improvement

Question 13

Hyatid cyst

Answer 13

albendazole
FNA under USS
surgery if not resolving
deworm pet dogs

Question 14

liver mets

Answer 14

chemo
resection if small
mostly palliative
prognosis <6months

Question 15

Malignant HCC

Answer 15

surgery if <3cm (50% recur in 3 years)
monitor with AFP
can also do chemo/embolization/percutaneous ablation

Question 16

benign tumors

Answer 16

only treat if symptomatic/ >5cm

Question 17

haematemesis/melanea

Answer 17

A--E
x match
blood tranfusion
ascitic tap
IV thiamine if withdrawal
prophylactic abx
urgent endocsopy, variceal banding
injection sclerotherapy
can use terlipressin/somatostatin to contrict
balloon tamponade

Question 18

Ascites

Answer 18

reduce sodium intake
increase sodium excretion
weigh
U&Es, Cr, eGFR
remove Na drugs
reduce Na to 40mmol over 24 hours
Sprinolactone
paracentesis
shunts

Question 19

Encephalopathy

Answer 19

avoid sedatives
20 degree head tilt
lactulose + regular enemas (decrease nitrogen forming bowel organisms)
20% mannitol if cerebral oedema

Question 20

bleeding oesophageal varices

Answer 20

A--E
cross match
Hb, PT/INR/ U&Es, Cr, LFTs blood cultures
vitamin k + FFP
prophylactic abx
IV terlipressin/somatostatin
endoscopic banding/sclerotherapy

Question 21

uncontrollable bleeding varices

Answer 21

minnesota/sengstaken bake more tube (balloon to compress varices)

Question 22

To prevent rebleeding oesophageal varices:

Answer 22

endoscopy
identify site
give 2 of:
-adrenaline
-sclerotherapy
-variceal bleeding
-argon plasma coagulation

Question 23

bleeding prophylaxis

Answer 23

non selective bblocker
repeat endoscopic band ligation
TIPS shunting
surgical shunt if TIPS difficult for technical reasons

Question 24

Splenectomy management

Answer 24

mobilise asap
vaccines: pneumococcal, HiB, Men C, Flu Jab
lifelong prophylactic penicillin V
medical alert jewellery + card
HX admission if any infection

Question 25

biliary colic

Answer 25

cholecystectomy for all symptomatic gallstones laparoscopically

Question 26

Acute cholecystitis

Answer 26

``` NBM IV fluids opioids IV abx - cefuroxime cold chole percutaneous cholecystostomy if surgery C/I ```

Question 27

unfit for cholecystectomy

Answer 27

stone dissolution | shock wave lithotripsy

Question 28

choledocholithiasis + acute cholangitis

Answer 28

IV cefuroxime urgent bile dict drainage ercp sphincterotomy, remove stones if well ill, insert stent and remove l8r

Question 29

pneumobillia

Answer 29

evidence of SBO (gall stone ileus)