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Check GS Notes as well (more on Gallstones, Cholecystitis)
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Primary sclerosing cholangitis
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Primary biliary cirrhosis
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#
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Young 🤵🏻
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Sclerosing: fibrosis
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Cholangiaits: inflammation of CBD
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intra & extra hepatic
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Common w/ UC
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⤴️ Risk for cholangiocarcinoma |
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Bitch: middle aged 👩🏻
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Interlobular bile duct destruction + portal triad
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⤵️ secretion of bile |
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Sx
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Early: Insidious onset:
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pruritus
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jaundice
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HSM
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Late:
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Cirrhosis (Liver failure /Ascites)
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portal HTN |
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pruritis
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chronic cholecystitis
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jaundice
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hyperlipidemia |
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Dx
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LFT: ⤴️ ALP / GGT
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ERCP: strings on beads appearance
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⊖ Anti-mitochondrial ab |
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LFT: ⤴️ ALP
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RUQ US: ⓝ
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⊕ Anti-mitochondrial ab (anti-mama) |
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Tx
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Endoscopic balloon / stent
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Liver transplantation in selected cases |
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1˚ Ursodeoxycholic acid
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Liver Transplant |
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Malignant Biliary Obstruction
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?
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Cholangiocarcinoma
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Pancreatic/HCC
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Metastasis (Colon, gastric) |
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Clx
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Jaundice,
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Pruritus, acholic stools, dark urine
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Weight loss
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RIJQ pain
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RUQ mass or hepatomegaly
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⤴️ Direct bilirubin, ALP, GGT |
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Dx
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Serum tumor markers (CEA, CA-19, AFP)
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Abdominal (US, CT scan)
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EUS or ERCP for tissue dx if unclear |
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Acute Cholangitis
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?
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Ascending infection due to biliary obstruction
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Clx
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Triad ∆:
Fever / RUQ Pain / Jaundice
Hypotension, AMS (Reynolds pentad)
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Dx
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🆎 Cholestatic LFT
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⤴️ Direct bilirubin, alkaline phosphatase
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Mildly ⤴️ aminotransferases
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Biliary dilation on abdominal US / CT |
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Tx
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Abx coverage of enteric bacteria
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ERCP w/i 24-48 h and drain biliary tree |
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Biliary cysts
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Path
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Type 1 cysts (most common): extrahepatic,
single cystic dilatation of the bile duct |
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S/S
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∆ of:
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pain,
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jaundice
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palpable mass
Majority present at age <10 years
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Dx
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US
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ERCP |
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Tx
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Surgical resection to relieve obstruction &
prevent malignant transformation |
Fast HY Review 