Ow: Jaundice and cholangitis cases -6

Question 1

80 y/o man feeling unwell, shivery and with a sore tummy

What to ask?

where sore = band across in top part of abdomen

how long = unwell 1 week with pain 3-4 days, present all the time with acute periods

No itching, dark urine (not drinking as much), intermittent yellow eyes

DD??

Answer 1

• Hepatitis - would give unwell and jaundice but probably not pain
• Gallstone disease - Cholilithiasis →choledocolithiasis, cholangitis
• Tumour - unlikely due to timeframe

Question 2

LFTs come back as….what to do next?

Patient gets acutely unwell while waiting for tests…?

Answer 2

Obstructuive mixed picture mostly cholestatic - associated with janudice

Wouldn’t be due to cholelithiasis but could be due to choledocolithiasis

Tumour still unlikely

Ultra sound - Shows GS in the GB but cant fully see CBD

MRCP - not therapeutic and doesn’t happen anytime fast

…CHOLANGITIS

Question 3

44 y/o female with cold and muscle aches

Some slight scleral jaundice - husband is unwell with same thing

What to ask?

Answer 3

Travel = none (hepatitis less likely)

Think OBSTRUCTIVE:

• GS → tummy pain? = none
• PSC, PBC → any abnormal LFT = none
• Tumor → weight loss? = none
• Drugs = none

Think HEPATITIS

• IV drug use = none
• Sexual partners = none
• Risk factors for chronic HepB→ SE asia, maori, pacific island
• Blood transfusion
• non-viral →alcohol?
• haemochromotosis → family history
• ischaemic hepatitis → acutely unwell

Think LIVER FAILURE:

• NAFLD

Question 4

LFTs come back as…

Answer 4

Hepatitic picture (some mild jaundice as well)

Could be viral - but would normally elevate more than this unless tailing off

NAFLD = can give milf hepatitis but normally more mixed

Haemochromotosis = check Iron and transferrin

Alcohol = history and GGT would normally be higher and AST > ALT

Tumour + obstruction = v unlikely as not obstructive picture