Tutorial 5 - Obstructive Jaundice

Question 1

Pre-hepatic, hepatic and post hepatic jaundice

-symptoms

Answer 1

Pre - un-conjugated, insoluble, not in urine
Hepatic - mixed
Post (obstructive) - stool pale, urine dark, itchy skin (conjugated, water-soluble billirubin)

Question 2

2 most common obstructive causes of Jaundice?

Answer 2

• gallstones

- stricture

Question 3

Cholelithiasis
Cholecystitis
Choledocolethiasis
Cholagnitis

Answer 3

Cholelithiasis - gallstones
Biliary collic - gallstones, sometimes obstructing
Cholecystitis - inflammed gallbladder
Choledocolethiasis - gallstone in common bile duct (pain + jaundice)
Cholagnitis - infected gallstone in common bile duct (pain + jaundice + fevers)

Question 4

Strictures

Most common cause?

Answer 4

benign or malignant
Painless jaundice

Benign - surgery, chronic pancreatitis scaring, or PSC

Malignant = more common, mets of tumors in common bile duct
-most common - adenocarcinoma of head of pancreas

Question 5

Cholesterol stones
pigment stones

-what are they made of?

Answer 5

(75% cholesterol)
-cholesterol, lecithin, bile salts (not radio-opaque, not seen on Xray)

Pigment - radio-opaque (can see on Xray)
-higher calcium content (billirubin, bile acids)

Question 6

Classic biliary collic pain

Triad of cholecysititis

US findigns

Answer 6

RUQ pain, comes on before 30min after fatty meal, N,V, pain radiates to top of right shoulder

Cholecystitis - fever, tender RUQ, tachycardia, murphys positive

Us - thickened gallbladder wall, pericholicystic fluid, gallstones in gallbladder

Question 7

Ascending cholangitis

-charctos triad

Answer 7

Pain, jaundice, rigors w fever = Charcots triad

Question 8

Stricture - malignancy

Answer 8

Jaundice + palpable gallbladder - malignancy

Stent - biliary stricture

Question 9

LFT - obstructive patter

Answer 9

Conjugated bilirubin, serum ALP, INR increase (because bile cannot digest fat solble viamins so no vit K made)

Question 10

Liver damage pattern

Answer 10

ALT, AST, GGT