HPB/Panc Flashcards
To DO
CLD/portal HTN
jaundice
biliary
acute panc
chronic panc
pseudocyst
panc Ca
Infective Hepatitis
Hep A (RNA): commonest; faeco-oral; notifiable; acute Hep B (DNA): body fluids; acute/chronic; CA risk; EXTRAHEP Sx common Hep C (RNA): body fluids; acute/chronic (80-85%); CA risk; often later incidental
EBV/mono: mild LFT, phary + fever
CMV: immosup;
other:
AIH
Sx: fatigue/TATT, weight loss, arthralgia, ameno, fever + jaundice
antibodies: anti-SM, ANA, LKM1, ^IgG
Bx: inflammation + bridgine necrosis
Tx: PO CST (remission) + azathioprine (lifelong)
Paracetamol OD
fatal: >150mg/kg, or 12g
symptoms: N&V, hep+AKI, RUQ pain, massive necrosis/failure
LFTs, coagulopathy, hypoglyc, enceph, MOF
NAC: immediate if fatal dose; or above treatment level (>4h)
prognosis: pH, INR/PT, Cr, enceph
Chronic Hepititis DDx
Hep B +/- D (D = ^risk of acute failure and cirrhosis)
Hep C (80-85% of Hep C)
AIH
alcohol
drugs: methyldopa, nitro
metabolic: Wilsons (neuro + jaundice), a1AT
Acute vs. Chronic presentation
Acute: ‘flu-like’ prodrome, fever, malaise, nausea/anorexia, abdo, arthralgia
jaundice, HSM, LA, rash
Chronic:
unresolved acute viral >6/12
non-specific Sx + abnormal LFT
positive routine screening
Hep B Serology
HBsAg: infected (acute or chronic)
HBeAg: highly infectious
anti-HBs: immune (vax/previous infection)
anti-HBe: low infectivity
anti-HBc IgG: past infection
anti-HBc IgM: current infection
- acute: HBs + anti-HBc (G+M)
- chronic: HBs + anti-HBc (G)
- recovered: anti-HBc (G) + anti-HBs
- immune: anti-HBs only
Acute liver failure DDx
oedema, jaundice, bleeding, cachexia, drug tox, IS, MOF
paracteamol (common) acute viral hepatitis (common) shock/ischaemia Budd-Chiari (hep vein thrombosis): pain, ascites, tender hepmeg Wilsons (neuro; Tx penicillamine) AIH: malaise, TATT, arthralgia, ameno
Drug-related hepatitis
acute hepitis:
paracetamol, aspirin, NSAIDs, anti-TB, hydralazine
cholestatic:
penicillins/macrolides/cipro, azathioprine, OCP, ACEI, anti-H, sulphon, chlorpromazine, amitrip
viral hepatitis treatment
Hep B acute: support, avoid alc, 95% recover
Hep B chronic: Peg-INFa, lamivudine, adefovir
Hep C chronic: mild = watchful wait; mod = Peg-ING2a/b + ribivirin
Jaundice
pre-hepatic: haemolytic; normal LFTs
hepatic: enzymes (conj) vs. hepatitis/failure/cirrho
* enzymes: normal LFTs and haemo; mild bili
* hepatitis: ALT/AST
post-hepatic: obstruction/cholestasis; ALP, GGT
- extrahepatic: CBD stone, cancer, PBC, PSC, cholangitis, panc
- intrahepatic: hepatitis, preggo, idio, infiltrate
Cirrhosis DDX + complications
ALD
NASH/NAFLD
chronic hepatitis
uncommon: AIH, PBC, PSC, CF, Wilson, haemochromo, Budd
portal hypertension (Varices, enceph, ascites, caput)
HRS: AKI (IV albumin, terlipressin, transplant)
HPS: hypoxia
HCC (AFP, poor prognosis)
liver failure: WKE; infection/alcohol/GI bleed trigger
Cirrhosis Ix
severity (CPS: alb, bili, PT, enceph, asc)
Dx: viral, Ab, Fe, AFP, a1AT, coppuer
USS + duplex: size, spleen, portal flow MRI: tumours, biliary obstr. nodules CT: HSM, CLD scope: varices ascitic tap: MC&S, SBP (neuts) biopsy: severity, type of CLD, stains (Fe, Cu, virus etc.)
Gallstone Fx
age, female, obesity, preggo/multiparity, OCP,
diet, DM, drugs, liver disease, FH, octreotide and ileal disease
Gallbladder disease
biliary colic: RUQ pain
cholecystitis: RUQ + fever/inflamm
ascending cholangitis: RUQ + jaundice + fevers/rigors (Charcot triad)
*pentad: triad + GCS/mental + shock
mirrizi: CBD compression from within sac; Bouveret: duo stone
gallstone ileus: SBO due to gallstones
pancreatitis
Ca: porcelin (AXR calcified)
*courvoisier’s: palpable gallbladder + jaundice = NOT gallstone
Rigors: pyeloneph, salpingitis, malaria, panc, meningitis
