Maggie

Question 1

describe biliary colic pain

Answer 1

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

Question 2

causes of biliary colic

Answer 2

• gall stones in duct - episodic pain as gallstiones pass and then come back

Question 3

cholecystitis

Answer 3

inflammation of gallbladder

• pain in RUQ
• murphys sign
• doesn’t typically cause colic pain on its own

(doesnt alone give jaundice)

Question 4

describe Murphys sign

Answer 4

prominent pain when taking a deep breath with an examining hand just below right costal margin

Question 5

what is ‘guarding’ and what does it imply

Answer 5

• 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

Question 6

why is cholesterol gallstones formed in the gallbladder not in the bile duct

Answer 6

• bile becomes concentrated in gallbladder, which can cause precipitation of cholesterol
  = gallstones

Question 7

what initiates emptying of gallbladder

Answer 7

cholecystokinin

Question 8

define cholelithiasis

Answer 8

presence of gallstones in the gallbladder solely

Question 9

define choledocholithiasis

Answer 9

presence of gallstones in the bile duct

• usually, cholesterol stones as they originate from gallbladder

Question 10

define cholangitis

Answer 10

presence of infection due to an obstructed bile duct

e.g. choledocholithiasis with infection

Question 11

what does increased GGT and ALP mean

Answer 11

patient has cholestasis

• decreased bile flow

Question 12

what is the diagnosis

• elevated GGT & ALP
• high fever and rigors
• elevated bilirubin
• US shows obstructed common bile duct

Answer 12

cholangitis due to choledocholithiasis

Question 13

consequences of cholangitis due to choledocholithiasis

Answer 13

pancreatitis - important to check pancreatic enzymes

common bile duct joined by pancreatic duct

Question 14

common causes of cholestasis

Answer 14

• stones
• biliary disease - autoimmune
  (e. g. primary biliary cirrhosis or primary sclerosing cholangitis)
• drugs & medications
• tumours

Question 15

Charcot’s triad and what it can means

Answer 15

• fever
• jaundice
• RUQ pain

= cholangitis

Question 16

describe MRCP

Answer 16

magnetic resonance cholangiopancreatography

• useful accurate visualisation of biliary tree
• advantage = non-invasive
• disadvantage = non-therapeutic (doesnt tx)

Question 17

describe ERCP

Answer 17

endoscopic retrograde cholangiopancreatography
- contrast

• diagnostic and therapeutic

disadvantages = risk of complications (bleeding or perforation)
- doesn’t prevent it occurring again

Question 18

describe PBC

Answer 18

• primary biliary cirrhosis
• autoimmune chronic cholestatic liver disease
• diagnosed by +ve AMA (anti-mitochondrial antibody)
• affects small intrahepatic bile ducts (not detectable on imaging)

Question 19

diagnosis of PBC requires what

Answer 19

2 out of the 3:

• high ALP (cholestasis)
• positive AMA
• liver biopsy

Question 20

presentation of PBC

Answer 20

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

Question 21

treatment for PBC

Answer 21

UDCA

• ursodeoxycholic
• slows down progression

Question 22

describe PSC

Answer 22

• primary sclerosing cholangitis
• chronic cholestastic liver disease
• affects extra- and intrahepatic bile ducts
• immune mediated but antigen unknown

Question 23

diagnosis of PSC

Answer 23

• radiology (MRCP/ERCP)

- occasionally requires liver biopsy

Question 24

presentation of PSC

Answer 24

• often associated with ulcerative colitis

early symptoms

• fatigue
• pruritus (itch even w/out jaundice)
• may have steatorrhoea

progressive disease

• jaundice
• liver cirrhosis
• cholangitis

Question 25

treatment for PSC

Answer 25

- no medication to slow - can dilate or stent strictures in large ducts - last resort liver transplant

Question 26

tumours causing obstructive jaundice

Answer 26

pancreatic cancer - head of pancreas cholangiocarcinoma (cancer of bile ducts) painless jaundice often tumour

Question 27

risk factors for viral hepatitis

Answer 27

- travel - IV drug use - sexual partners - vaccinations - blood transfusions

Question 28

what is commonly associated with PSC

Answer 28

- osteoporosis | - ulcerative colitis