Liver - Useful Passmed facts

Question 1

Drugs that can cause a cholestatic picture?

Answer 1

The following drugs tend to cause cholestasis (+/- hepatitis):

• combined oral contraceptive pill
• antibiotics: flucloxacillin, co-amoxiclav, erythromycin
• anabolic steroids, testosterones
• phenothiazines: chlorpromazine, prochlorperazine
• sulphonylureas
• fibrates
• rare reported causes: nifedipine

Question 2

What are signs you would see in cholangiocarcinoma?

Answer 2

A palpable mass in the right upper quadrant (Courvoisier sign)

periumbilical lymphadenopathy (Sister Mary Joseph nodes)

left supraclavicular adenopathy (Virchow node) may be seen

Question 3

What do you see in biliary colic, AC, Ascending cholangitis

Answer 3

RUQ pain- colic
RUQ pain plus fever- cholecystitis
RUQ pain plus fever plus jaundice (charcot triad)- cholangitis
epigastric pain- more likely pancreatitis