Maggie Flashcards
describe biliary colic pain
is a symptom not a diagnosis
pain can radiate to right flank and even tip of shoulder blade
tends to increase post meals
pain builds up in waves and comes and goes
causes of biliary colic
- gall stones in duct - episodic pain as gallstiones pass and then come back
cholecystitis
inflammation of gallbladder
- pain in RUQ
- murphys sign
- doesn’t typically cause colic pain on its own
(doesnt alone give jaundice)
describe Murphys sign
prominent pain when taking a deep breath with an examining hand just below right costal margin
what is ‘guarding’ and what does it imply
- examining for a tightening or muscle contraction
- can be both voluntary and involuntary
- involuntary is a sign of peritoneal inflammation e.g. seen in cholecystitis and appendicitis
- rebound tenderness
why is cholesterol gallstones formed in the gallbladder not in the bile duct
- bile becomes concentrated in gallbladder, which can cause precipitation of cholesterol
= gallstones
what initiates emptying of gallbladder
cholecystokinin
define cholelithiasis
presence of gallstones in the gallbladder solely
define choledocholithiasis
presence of gallstones in the bile duct
- usually, cholesterol stones as they originate from gallbladder
define cholangitis
presence of infection due to an obstructed bile duct
e.g. choledocholithiasis with infection
what does increased GGT and ALP mean
patient has cholestasis
- decreased bile flow
what is the diagnosis
- elevated GGT & ALP
- high fever and rigors
- elevated bilirubin
- US shows obstructed common bile duct
cholangitis due to choledocholithiasis
consequences of cholangitis due to choledocholithiasis
pancreatitis - important to check pancreatic enzymes
common bile duct joined by pancreatic duct
common causes of cholestasis
- stones
- biliary disease - autoimmune
(e. g. primary biliary cirrhosis or primary sclerosing cholangitis) - drugs & medications
- tumours
Charcot’s triad and what it can means
- fever
- jaundice
- RUQ pain
= cholangitis
describe MRCP
magnetic resonance cholangiopancreatography
- useful accurate visualisation of biliary tree
- advantage = non-invasive
- disadvantage = non-therapeutic (doesnt tx)
describe ERCP
endoscopic retrograde cholangiopancreatography
- contrast
- diagnostic and therapeutic
disadvantages = risk of complications (bleeding or perforation)
- doesn’t prevent it occurring again
describe PBC
- primary biliary cirrhosis
- autoimmune chronic cholestatic liver disease
- diagnosed by +ve AMA (anti-mitochondrial antibody)
- affects small intrahepatic bile ducts (not detectable on imaging)
diagnosis of PBC requires what
2 out of the 3:
- high ALP (cholestasis)
- positive AMA
- liver biopsy
presentation of PBC
50-60 % are asymptomatic
early symptoms
- fatigue
- pruritus (itch even w/out jaundice)
- may have steatorrhoea
progressive disease
- jaundice
- liver cirrhosis
will get progressive increase in ALP and GGT
treatment for PBC
UDCA
- ursodeoxycholic
- slows down progression
describe PSC
- primary sclerosing cholangitis
- chronic cholestastic liver disease
- affects extra- and intrahepatic bile ducts
- immune mediated but antigen unknown
diagnosis of PSC
- radiology (MRCP/ERCP)
- occasionally requires liver biopsy
presentation of PSC
- often associated with ulcerative colitis
early symptoms
- fatigue
- pruritus (itch even w/out jaundice)
- may have steatorrhoea
progressive disease
- jaundice
- liver cirrhosis
- cholangitis
treatment for PSC
- no medication to slow
- can dilate or stent strictures in large ducts
- last resort liver transplant
tumours causing obstructive jaundice
pancreatic cancer
- head of pancreas
cholangiocarcinoma (cancer of bile ducts)
painless jaundice often tumour
risk factors for viral hepatitis
- travel
- IV drug use
- sexual partners
- vaccinations
- blood transfusions
what is commonly associated with PSC
- osteoporosis
- ulcerative colitis
