DR Medhat MRCP

• Diagnosis:
Contrast CT is used for diagnosis and assessment of invasion.
ERCP restricted to palliative care
CA 19-9
U/S abdomen is less reliable when the tumor is in the body or tail
• Management :
1) Surgical intervention
- Represents the only chance of long-term survival with < 20%
suitable for surgery at diagnosis.
- Eligibility for resection depend on:
o Tumor size < 4cm
o Invasion of superior mesenteric artery or portal vein
o Presence of mets
o Radio and chemotherapy are ineffective.
هام جدا disease: Drug-related liver
Drugs causing acute hepatitis
1) Alcohol.
2) Amiodarone
3) Anti-TB :
Rifampicin,INH,Pyrizinamide
4) Halothane
5) MAOI
6) Methyl dopa
7) Sodium valproate,phenytoin
8) Statins
9) Paracetamole.
Drugs causing cholestaisis
(+/- hepatitis)
1) Anabolic steroids,testosterone
2) Antibiotics :
Flucloxacillin
Co-amoxclav (augmentin)
Erythromycin
Nitrofurantoin.
3) oral contraceptive pills.
4) Fibrates.
5) Phenothiazine
6) Chloropromazine
7) Sulphonylurea
8) Rarely : nifidepine.
Drugs causing
cirrhosis
1) Methotrexate.
2) Amiodarone
3) Methyl dopa
Paracetamol overdose: management
- The following is based on 2012 Commission on Human Medicines (CHM) review of
paracetamol overdose management.
- The big change in these guidelines was the removal of the 'high-risk' treatment line
on the normogram. All patients are therefore treated the same regardless of risk
factors for hepatotoxicity.
- The National Poisons Information Service/TOXBASE should always be consulted for
situations outside of the normal parameters.
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