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Liver, gallbladder & jaundice

From bile acids to the jaundiced patient: the physiology first, then the bedside, then the tests.

Written and clinically reviewed by , consultant minimally invasive and bariatric surgeon, Al-Makassed Hospital, Jerusalem, and Assistant Professor of Surgery, Al-Quds University. Last updated .

Most of surgical jaundice makes sense once you follow bile around its circuit. Start with the enterohepatic circulation, then the three types of jaundice, then the liver function tests — in that order, each page builds on the one before.

In this topic

Bile & the gallbladder

GuideThe enterohepatic circulationBile acids in ten steps, from synthesis to signalling.GuideEmulsification vs micellesTwo stages, two jobs, and the mistake examiners notice.GuideBile acid diarrhoeaAfter an ileal resection: when a sequestrant helps.

Jaundice & liver tests

GuideThe three types of jaundicePre-hepatic, hepatic and post-hepatic.GuideBilirubin metabolismDirect and indirect bilirubin, and where it fails.GuidePale stools and dark urineThe classic question, answered from the pathway up.GuideLiver function testsALT, AST, ALP, GGT and bilirubin: three patterns.GuideWhy the INR risesVitamin K needs micelles.GuideCourvoisier’s lawWhat it says, and the exceptions.GuideJaundice history takingSix questions and a model summary for the OSCE.CalculatorR-factor calculatorHepatocellular, mixed or cholestatic?

Practise

Clerk this patientRight upper quadrant painA simulated patient with a scored debrief.Model clerkingRight upper quadrant painThe history as it should read on the ward.Model clerkingPainless progressive jaundiceA model clerking with key boxes.OSCE stationResults station 1Hepatobiliary results.OSCE stationResults station 4Hepatobiliary results.OSCE stationImaging station 5Hepatobiliary imaging.OSCE stationEquipment station 5Hepatobiliary equipment.OSCE stationAntibiotics for acute cholecystitisA prescribing station.

The book

Free bookBile and Jaundice31 illustrated pages, free to download.

Test yourself: Champion

7 rapid-recall questions on this topic, thirty seconds each.

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36Test yourself: Hepatobiliary & pancreas MCQs
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Calculators for this topic

Child-Pugh · Pancreatitis severity · MELD score

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