Liver + Biliary 2 Flashcards
Liver failure definition and causes?
Severe liver dysfunction leading to jaundice, encephalopathy and coagulopathy
Acute: paracetomol overdoes (transaminitis +++) (50% of ALF)/viral
Acute on chronic : acute decompensation in patients with chronic liver disease
Breakdown of Acute liver failures?
Hyperacute: encephalopathy <7 days after jaundice
Acute: Enceph 1-4 weeks after jaundice
Subacute: enceph 4-12 weeks after jaundie
Ix for liver failure?
Identify cause e.g. viral serology, paracetomol levels, liver biopsy, bloods and coagulation screen
What is a liver abscess/cyst and Hx?
Liver infection -> walled off collection of pus/cyst fluid
Fever, malaise, RUQ pain (referred to shoulder), jaundice and foreign travel
Examination of liver abscess/cysts?
Jaundice, tender hepatomegaly, dullness on percussion, decreased breath sounds at right lung base
Breakdown of liver abscess/cysts?
Pyogenic abscess: S aureus (kids), Ecoli (adults).
60% related to bilairy dises e.g gallstones, strictire
Amoebic Abscess: entamoeba histolytica (faeco-oral) from amoebic dysentery. Metronidazole Tx
Hyatid cyst: Tapeworm e.g. echinococcus grnaulosis infection. Can be large, sheep rearing countries. Mebendazole Tx
TB : extrapulmonary manifestaion
Ix for liver abscess or cysts?
Bloods = FBC - mild anaemia, leukocytosis
Eosinophilia for hyatid cyst
Stool microscopy for entamoeba and echinococcus granulosis
Aspiration/culture for ascess: pyogenic = polymicrobial, amoebic = anchovy sauce with necrotic hepatocytes/trophozoites)
What is cholangitis and triad associated?
ascending infection of the bile ducts, usually by E.coli, in stagnant bile
Charcots: pain, fever, jaundice
Pancreatic cancer features?
Courvoisiers Law: painless jaundice + palpable gall bladder likely to be pancreatic cancer (head)
Marker is Ca19-9
Cholangiocarcinoma features?
Gradual onset obstructive pattern and can originate from PSC
PSC vs PBC?
Both From Autoimmune conditions but UC for PSC
Ix for gallstones?
Biliary colic = cholelithiasis + pain
Acute cholecystitis = cholelithiasis + inflammation + secondary infection
None have jaundice
Ix - USS liver and biliary tree
What is it if there is mild jaundice in acute cholecystitis?
Inflammation of the contiguous biliary ducts is Mirizzis syndrome
Mx for gallstones?
Biliary colic = analgesia + electve lap chole
Acute cholecystitis = Inital: clear flids, analgesics, fluid resus and broad IV Abc
Lap Chole in a week
What is a gallstone in the CBD and other conditions?
Choledocholithiasis
Choledocholithiasis +pain = biliary colic
^ + infection = ascending cholangitis
Ix for choledocholithiasis and associated conditions?
May be jaundice/raised ALP and GGT
USS liver and biliary tree
ERCP if suspected acute cholangitis
Management of choledocholithiasis and biliary colic?
Analgesia + ERCP + lap chole
Management for ascending cholangitis?
Initial: clear fluids only, analgesics, fluid resusc, Broad IV ABx + ERCP
Lap Chole
Complications of acute cholecystitis?
Gallblader empyema, porcelain gallbladder, GB cancer, gallstone ileus
complications of acute chlangitis?
Bile duct perforation, bile peritonitis and sepsis
Risk factors for gallstones and types?
Fair, fat, fertile, female, forty, +OCC, crohns
Cholesterol 10%
Mixed 80%
Pigment stones (5%) = calcium bilirubinate from haemolysis or liver fluke
Primary Biliary cirrhosis features?
Intrahepatic ducts only F>m Histology = florid duct lesion Associated with Sjorens and RA Rasied AMA usually diagnostic
Complication = cirrhosis, HCC and GRANULOMAS
PSC features?
Intra and extrahepatic ducts
M>F
Histology = concentric onion skin fibrosis
ASSOCIATED WITH UC
Diagnosis with MRCP = beaded appearance or segmental fibrosis with saccular dilatation
pANCA may be raised
Complications = irrhosis, HCC< cholangiocarcinoma
Pancreatic cancer types and Rfs?
Coursevoirs
Mostly adenocarcinoma in head 75%
Ca19-9 and MEN1
Smoking, obesity, T2dm, chronic pancreatitis
S+S of pancreatic cancer?
Commonl delayed presentation due to non-specific signs e.g. malaise, weight loss, abdo pain
Jaundice is later and hepatomgealy if mets
Ix for pancreatic cancer>
1st = CT more sensitive, can do USS
Biopsy via ERCP/EUS is gold standard
Ca19-9
Liver tumour types?
Secondary most common from bowel, breast, oesophagus, stomach and pancreas
Primary = HCC 90% and cholangiocarcinoma
RFs for HCC (hepatoma)
Hep B (worldwide)/C (europe), Alcoholic liver disease, AIH, haemochromotisis, NAFLD, aflatoxin, PBC< smoking, obesity
S+S HCC?
Malaise, weight loss, anorexia, RUQ pain, jaundice, ascites, cachexia, heatomgealy
Ix for HCC?
LFTS and viral serology
Tumour marker = AFP
6 month USS for at high risk and 2ww for liver mass
Liver CT to confirm
Biopsy is gold standard
Chongiocarcinoma Rfs and S+S?
PSC, worm infections and cirrhosis.
Same as pancreatic cancer symptoms but pancreatic more common
Ix for cholangiocarcinoma?
1st - abdo uss (dilated intrahepatic ductss, mass lesion)
Biopsy via ERCP gold standard
