| Show Learning Points most relevant to Phase 1: |
Patient with jaundice
| Clinical Discipline(s)/Organ System(s) Digestive System, General Surgery, Gastroenterology & Hepatology | Progress Test Topic(s) |
Description
A 67 year old Cook Island Māori man presents to his GP after his wife commented that he had 'gone yellow'. He has recently been feeling fatigued and suffers from bouts of abdominal pain, especially after eating. The GP asks if you can take a history before they see the patient. You speak to him and he tells you that his stool is pale and his urine is dark.
Progress Test-Type Questions: Question 1 | Question 2 | Question 3Applied Science for Medicine
- Anatomy of the liver and its functions; include microscopic detail of lobules and the relationship between the portal and hepatic blood supplies and the bile ductules
- Anatomy and function of the biliary tree and pancreas
- Pathophysiology of portal hypertension
- Production and excretion of bilirubin
- Types of gallstones
- Pharmacology of penicillins, fluoroquinolones, macrolides, extended spectrum penicillins and aminoglycosides
- How vaccinations induce an immune response
- Anatomy of the liver and its functions; include microscopic detail of lobules and the relationship between the portal and hepatic blood supplies and the bile ductules
- Anatomy and function of the biliary tree and pancreas
- Pathophysiology of portal hypertension
- Production and excretion of bilirubin
- Types of gallstones
- Pharmacology of penicillins, fluoroquinolones, macrolides, extended spectrum penicillins and aminoglycosides
- How vaccinations induce an immune response
Clinical and Communication Skills
- History from a jaundiced patient; include risk factors for hepatitis virus infection, drug, alcohol, sexual, travel and occupational information
- Recognise jaundice, signs of chronic liver disease and perform an examination of the abdomen
- Classification and differential diagnosis of jaundice
- Indications for ultrasound abdomen, CT abdomen, endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), liver biopsy
- Interpret liver function tests, albumin, coagulation screen, hepatitis serology
- Management of obstructive and non-obstructive jaundice, acute liver failure, gallstone disease
- Outline the management of pancreatic cancer: surgery, oncology, palliative
- Prognosis of pancreatic cancer
- History from a jaundiced patient; include risk factors for hepatitis virus infection, drug, alcohol, sexual, travel and occupational information
- Recognise jaundice, signs of chronic liver disease and perform an examination of the abdomen
- Classification and differential diagnosis of jaundice
- Indications for ultrasound abdomen, CT abdomen, endoscopic ultrasound, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), liver biopsy
- Interpret liver function tests, albumin, coagulation screen, hepatitis serology
- Management of obstructive and non-obstructive jaundice, acute liver failure, gallstone disease
- Outline the management of pancreatic cancer: surgery, oncology, palliative
- Prognosis of pancreatic cancer
Personal and Professional Skills
- Deliver life-changing news
- Empathise with a patient with cancer
- Communicate with patient and family/whanau in relation to death and dying
- Deliver life-changing news
- Empathise with a patient with cancer
- Communicate with patient and family/whanau in relation to death and dying
Hauora Māori
- Cater for differential health literacy needs of Māori patients and whānau
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand in presentations of jaundice (e.g. hepatitis, cancer)
- Understanding of inequities in health outcomes for Māori compared with non-Māori including liver cancer rates 4 times higher in Māori than non-Māori, and application of this to clinical decision making and management
- Consideration of access to cultural/spiritual support for patient and whānau
- Understanding of the role of kaupapa Māori cancer and health policies, services and research in reducing inequalities
- Cater for differential health literacy needs of Māori patients and whānau
- Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand in presentations of jaundice (e.g. hepatitis, cancer)
- Understanding of inequities in health outcomes for Māori compared with non-Māori including liver cancer rates 4 times higher in Māori than non-Māori, and application of this to clinical decision making and management
- Consideration of access to cultural/spiritual support for patient and whānau
- Understanding of the role of kaupapa Māori cancer and health policies, services and research in reducing inequalities
Population Health
- Epidemiology of pancreatic cancer and gallstones
- Epidemiology of pancreatic cancer and gallstones
Conditions to be considered relating to this scenario
Common
gallstones, drug-induced liver disease, cholecystitis, pancreatic adenocarcinoma, external compression of bile duct, liver metastases
gallstones, drug-induced liver disease, cholecystitis, pancreatic adenocarcinoma, external compression of bile duct, liver metastases
Less common but 'important not to miss'
hepatocellular carcinoma, primary biliary cirrhosis, cholangiocarcinoma, liver abscess
hepatocellular carcinoma, primary biliary cirrhosis, cholangiocarcinoma, liver abscess
Uncommon
amyloidosis, haemochromatosis
amyloidosis, haemochromatosis
