Chapter 11: GASTROENTEROLOGY

LIVER DISEASE

CONGENITAL HEPATIC FIBROSIS

Congenital hepatic fibrosis is associated with POLYCYSTIC KIDNEY DISEASE and can lead to varices and portal hypertension.

HEPATOMEGALY

Hepatomegaly is defined as a palpable liver > 1 cm below the costal margin, or a liver that crosses the midline. A palpable liver edge is normal and is especially notable in a newborn.

GALLBLADDER HYDROPS

Gallbladder hydrops refers to RUQ pain from acute swelling or distension of the gallbladder in the absence of any gallstones. It may be associated with FASTING, IGA VASCULITIS, KAWASAKI SYNDROME, STREP PHARYNGITIS, and TPN.

MNEMONIC: Imagine a Las Vegas “STREPPer” who has breasts that look like giant GREEN WATER BALLOONS. She’s riding a KAWASAKI motorcycle through a drive-thru to get a BURGER IN A BAG. She gets on the road; her speedometer only reads FAST or slow. She goes FAST, but when she tries to eat her BURGER IN A BAG, she flies off the bike and gets BRUISES on her BUTT and LEGS.

• KEY: STREPPer = Strep pharyngitis, GREEN WATER BALLONS = Gallbladder, KAWASAKI = Kawasaki Syndrome, BURGER IN A BAG = TPN, and the BRUISED BUTT and LEGS = IGA VASCULITIS.

HEPATOBLASTOMA

A hepatoblastoma is a malignant liver neoplasm in infants and children. It usually presents as an abdominal mass by 3 years of age. ALPHA-FETOPROTEIN (AFP) levels are high. The prognosis is poor.

PRIMARY SCLEROSING CHOLANGITIS (PSC)

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease resulting from autoimmune inflammation leading to fibrosis of the intrahepatic and extrahepatic biliary tree. It is diagnosed with CHOLANGIOGRAPHY (AKA ERCP or endoscopic retrograde cholangiopancreatography), which looks for beading and stenosis of the biliary ducts. ULCERATIVE COLITIS and elevated p-ANCA ((Perinuclear Anti-Neutrophil Cytoplasmic Antibodies) levels are both frequently associated with PSC. “PSC often = UC.”

PEARL: Since the biliary tree is affected, look for GGT elevation. Bilirubin levels are elevated in the ad­vanced stages.

MNEMONIC: Get a G-G-T to check the bili-ary-tree!

HEPATOBILIARY IMINODIACETIC ACID SCAN (AKA HIDA SCAN or CHOLESCINTIGRAPHY)

A hepatobiliary iminodiacetic acid scan (AKA HIDA scan or cholescintigraphy) utilizes a nuclear medicine tracer that is injected into an IV. The gallbladder should then be visible within one hour post-injection. If the gallbladder is not seen, there is either CHOLECYSTITIS or CYSTIC DUCT OBSTRUCTION.

IMAGE: www.pbrlinks.com/HIDASCAN1