HEPATOPANCREATOBILIARY Tom Drake and Fran Young. THE BILIRUBIN CYCLE.
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Transcript of HEPATOPANCREATOBILIARY Tom Drake and Fran Young. THE BILIRUBIN CYCLE.
![Page 1: HEPATOPANCREATOBILIARY Tom Drake and Fran Young. THE BILIRUBIN CYCLE.](https://reader036.fdocuments.in/reader036/viewer/2022062516/56649dab5503460f94a9a6a1/html5/thumbnails/1.jpg)
HEPATOPANCREATOBILIARY
Tom Drake and Fran Young
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THE BILIRUBIN CYCLE
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LIVER FUNCTION TESTS
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Hepatotoxicity
• ALP- Cholestasis
• ALT-Hepatocyte damage
• yGT-Cholestasis
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Synthetic Liver Function
• Albumin
• PT- Prolonged in almost all liver problems- Cholestasis to do with Vit K
• INR
• Protein/Globulin
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CLINICAL EXAMINATION
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Clinical Examination
• Gynaecomastia
• Spider Naevi
• Palmar erythema
• Caput medusae
• Bleeding
• Jaundice
• Bruising
• Encephalopathy
• Murmurs (Cruveilhier-Baumgarten)
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ASCITES
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JAUNDICE
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Pre-Hepatic Causes
• Haemolysis
• Genetic
• Symptoms?
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Hepatic Causes
• Hepatitis
• Drug Toxicity
• Liver disease (Cirrhosis, NAFLD)
• Infections
• Symptoms?
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Post-Hepatic Causes
• Any obstruction of the biliary tree
• Causes
• Symptoms?
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Liver
• Hepatitis
• Cirrhosis
• Malignancy
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Hepatitis
• Viral
• Autoimmune
• Drug-induced
• NAFLD
• Ischaemic
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Viral Hepatitis
• A, B, C, D, E
• B and D
• High-risk group
• Investigation
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Viral Hepatitis
• A, B, C, D, E
• B and D
• High-risk groups
• Investigation
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Viral Hepatitis
• Acute phaseNausea, vomiting, appetite, jaundiceHep C
• Chronic phase
• Outcomes-50% of Hepatocellular Carcinoma-Liver failure
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Alcoholic Hepatitis and NAFLD
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Cirrhosis
• Replacement of liver tissue by fibrosis and regenerative nodules
• End stage liver disease
• Irreversible loss of liver function
• Decompensated Cirrhosis
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Biliary Tree
• Cholecystitis
• Ascending Cholangitis
• Primary Biliary Sclerosis
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Acute Pancreatitis
• Causes
• Investigation
• Glasgow and VAPOR
• Treatment-Fluids-Pain Relief-?Antibiotics
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Acute Pancreatitis
• Causes
• Investigation
• Glasgow and VAPOR
• Treatment-Fluids-Pain Relief-?Antibiotics
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Acute Pancreatitis
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Acute Pancreatitis
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Chronic Pancreatitis
• Causes
• Investigation
• Treatment
• Pancreatic insufficiency
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Cholecystitis
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Cholecystitis
• Symptoms
• Causes
• Examination
• Investigation
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Choledocholithiasis /Cholecystitis
• What is says on the tin.
• ERCP/MRCP
• “Hot” Lap-chole
• Fluids and antibiotics
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Ascending Cholangitis
• Causes
• Symptoms- Charcot’s Triad
• Investigation
• Treatment
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Pancreatic Cancer
• Bad.
• Risk Factors
• Causes
• Types
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Pancreatic Cancer
• Symptoms
• Signs
• Investigation
• Treatment
• Prognosis
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QUESTIONS