CRACKcast E090 - Disorders of Liver & Biliary Tract

This episode covers Chapter 80 of Rosen's Emergency Medicine 9th edition. (Yes the new edition). Building on previous episodes (see fever, Jaundice and abdo pain), today we take a look at all things right upper quadrant badness.

 

1) List 8 ddx for hepatitis

 

2) Complete the following table for Hepatitis A, B & C: Transmission, Risk Factors, Carrier State, Acute Infection, Previous Infection, Chronic Infection, Prev Vaccine, Transmission Risk, Vaccine.

 

(show notes: What is hepatitis E? Where is it commonly found (geographically)? What is the significance of hepatitis D?)

 

3) Describe the post-exposure prophylaxis for exposure to HepA, HepB, HepC

 

4) Compare the expected lab work in acute viral hepatitis vs EtOH hepatitis

 

5) What liver diseases are associated with alcohol abuse? What non-hepatic conditions are associated with alcohol abuse? Describe the management of EtOH hepatitis

 

6) List 6 stigmata of chronic liver dz and list 3 complications

 

7) How is are chronic cirrhosis and ascites managed in the ER?

 

8) Describe a grading scale for hepatic encephalopathy and list 5 management considerations

 

9) Describe the ER diagnosis and management of SBP.

 

10) List 3 types of drug-induced liver disease.

 

11) What are two types of hepatic abscesses? How are they diagnosed and treated?

 

12) What is budd-chiari syndrome? How is it managed?

 

13) What is primary sclerosing cholangitis (PSC)? What is primary biliary cirrhosis? What is PSC associated with?

 

14) List 6 RFs for Cholelithiasis

 

15) Describe the clinical presentation of cholecystitis. List Lab, Xray (3) and US (4) findings

 

16) List 4 patients that get acalculous cholecystitis

 

17) List 4 considerations in the management of acute cholecystitis. When is surgery performed early?

 

18) What is the classic presentation of ascending cholangitis? What two clinical eponyms are described? How is ascending cholangitis managed?

Wisecracks:

 

1.. Which conditions are associated with transaminases in the 10000s?

2. How do you approach a patient with a needlestick injury? What is the risk of transmission following a needlestick?
3. What are underlying causes of hepatic encephalopathy in patients with known liver disease?
4. What are the typical investigations performed on ascites fluid? What is the SAAG and how is it interpreted?
5.  What is the significance of a calcified gallbladder?