HEPATOPANCREATOBILIARY Tom Drake and Fran Young. THE BILIRUBIN CYCLE.

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Presentation transcript:

HEPATOPANCREATOBILIARY Tom Drake and Fran Young

THE BILIRUBIN CYCLE

LIVER FUNCTION TESTS

Hepatotoxicity ALP- Cholestasis ALT-Hepatocyte damage yGT-Cholestasis

Synthetic Liver Function Albumin PT- Prolonged in almost all liver problems- Cholestasis to do with Vit K INR Protein/Globulin

CLINICAL EXAMINATION

Clinical Examination Gynaecomastia Spider Naevi Palmar erythema Caput medusae Bleeding Jaundice Bruising Encephalopathy Murmurs (Cruveilhier-Baumgarten)

ASCITES

JAUNDICE

Pre-Hepatic Causes Haemolysis Genetic Symptoms?

Hepatic Causes Hepatitis Drug Toxicity Liver disease (Cirrhosis, NAFLD) Infections Symptoms?

Post-Hepatic Causes Any obstruction of the biliary tree Causes Symptoms?

Liver Hepatitis Cirrhosis Malignancy

Hepatitis Viral Autoimmune Drug-induced NAFLD Ischaemic

Viral Hepatitis A, B, C, D, E B and D High-risk group Investigation

Viral Hepatitis A, B, C, D, E B and D High-risk groups Investigation

Viral Hepatitis Acute phase Nausea, vomiting, appetite, jaundice Hep C Chronic phase Outcomes -50% of Hepatocellular Carcinoma -Liver failure

Alcoholic Hepatitis and NAFLD

Cirrhosis Replacement of liver tissue by fibrosis and regenerative nodules End stage liver disease Irreversible loss of liver function Decompensated Cirrhosis

Biliary Tree Cholecystitis Ascending Cholangitis Primary Biliary Sclerosis

Acute Pancreatitis Causes Investigation Glasgow and VAPOR Treatment -Fluids -Pain Relief -?Antibiotics

Acute Pancreatitis Causes Investigation Glasgow and VAPOR Treatment -Fluids -Pain Relief -?Antibiotics

Acute Pancreatitis

Chronic Pancreatitis Causes Investigation Treatment Pancreatic insufficiency

Cholecystitis

Symptoms Causes Examination Investigation

Choledocholithiasis /Cholecystitis What is says on the tin. ERCP/MRCP “Hot” Lap-chole Fluids and antibiotics

Ascending Cholangitis Causes Symptoms- Charcot’s Triad Investigation Treatment

Pancreatic Cancer Bad. Risk Factors Causes Types

Pancreatic Cancer Symptoms Signs Investigation Treatment Prognosis

QUESTIONS