Jaundice

Question 1

What investigations do we usually do for liver suspecions?

Answer 1

FBC,
LFTs
Liver function (INR + albumin)
Abdo USS
Viral markers- intra hepatic cholestasis?

Question 2

What will an Abdo USS show in extra hepatic obstruction?

Answer 2

1. Dilatation of the intra- hepatic biliary tree
2. Dialatation of CBD
3. Gall stones in GB
4. GS in biliary tree
5. Metastatic liver disease
6. Pancreatic mass. Or GS obstructing pancreas

GS–> ERCP.
6. Endoscopic USS + / or CT scan should be performed to asses operability.
ERcP w/ stent placement through the stricture will relieve jaundice.

Question 3

How is the ERCP useful?

Answer 3

1. Enable better visualisation
2. Allow removal of gs.

A sphincterectomy needed from before, to take it out.
If too large: stone is crashed.

Elderly: stent insertion to maintain drainage open

Question 4

What happens in cholangitis?

Answer 4

Often accompinies gall stones and urgent duct drainage needed +. Antibiotics: ciptofloxacin 500mgx2.

The residual Gall stones are removed endoscopically when pt is stable

Question 5

When is painless jaundice common?

Answer 5

Carcinoma pf pancreas but with gall stones there is usually a hx of biliary pain accompanying jaundice.

Or cholangiocarcinoma? Younger age.

Question 6

Whatbare some complications of ERCP?

Answer 6

Bleeding severe in 2%
Perforation
Acute pancreatitis (5%)
Cholangitis

Question 7

20 year old F coming back from india, confused and deeply jaundiced. Subconjucival haemorrhage. What could it be?

Answer 7

Fulminant hepatic failure
Essential to stabilise her.
Central venous line is inserted and as her Hb was low, given 2 units of fresh red blood cells.

Clotting studies- liver indication
Make sure K+ is fine + Blood glucose.

Investigations:
Hb, clotting studies, 
Albumin, liver enzymes
Blood sugar
U+Es

Question 8

How is hepatic encephalopathy treated?

Answer 8

Low protein diet and lactulose

Question 9

When is it detected?

Answer 9

When serum bilirubin is >50mml/L (3mg/dL)