Liver Diseases Explained Clearly – Cholestatic Disease okay, so welcome to another medcram lecture. We’re continuing our discussion about actual diseases in terms of cholestatic liver disease. And so let’s go ahead to the table. Okay. So here are three major diseases. We’ve got primary biliary cirrhosis. We’ve got primary sclerosing cholangitis and we’ve got large bile duct obstruction. Let’s talk about primary biliary cirrhosis first in this area, and we’ve got these categories.

Alkaline phosphatase total bilirubin history and diagnosis so primary biliary. Cirrhosis is more common in women, it causes fatigue and itching so think about a woman whose itching

And how some jaundiced or the elk Foss is going to be definitely elevated and that’s because what this primary biliary cirrhosis is, it’s like little portal granulomas.

So little granulomas affecting the portal area and you get destruction of the intrahepatic biliary Ducks. So this is intra Paddock destruction of the biliary Ducks. We see this in middle-aged women and you do get an increase in cholesterol retention. It can be asymptomatic for years or even decades. So what you see is a high alkaline phosphatase you

Actually also see a high cholesterol as we mentioned and the bilirubin does go up but it doesn’t go up until later in the disease. Here’s the key though for the diagnosis. Okay, and this is what they’re going to test you on is you’re going to have positive and tea.

Might so chondral antibodies. That’s the key positive anti mitochondrial antibodies in more than 95% of the time you can diagnosis with liver biopsy. Okay. So if you’ve got lady fits into this category, make sure you get an anti mitochondrial antibody. Okay. Let’s talk about primary sclerosing cholangitis now with this whereas this was just intrahepatic now, we’re talking about both ends.

Ra and extra hepatic duct all problems its associated with actually ulcerative colitis.

Okay, so you think about those type of inflammatory diseases what you’re seeing here is fibro sinkhole and gitis of the biliary ducts and what you’ll see is kind of like a beads on a string type of appearance if you were to do a collab angiogram. So you’ll have this fibrosis. There’s the biliary duct and then you’ll have this fibrosis fibrosis fibrosis.

So it looks like beads on a string if you were to do a Colangelo Graham. Okay. So this be to the parents makes you think of sclerosing cholangitis, and so the diagnosis is actually a

Cole NGO Clan geography if you will

That means you just shoot die in there and you can see it light up. It’s pretty interesting to see that. So the beaded appearance is almost pathognomonic and its associated with these diseases and it looks very similar to primary biliary cirrhosis in terms of lab. So you get the elevated alphas and you get this total bilirubin elevation. Okay. What about large bile duct obstruction again, because Alphas is an inducible enzyme you’ll see that you’ll also see increased T Billy here. However, because you actually have a

Bile duct obstruction. This is going to look like gallbladder disease or cholecystitis. You’re going to get pain. You’re gonna get fever.

Okay, these type of things and the diagnosis here again is you can do: geography you could also do ultrasound you could do an ercp. That’s endoscopic retrograde cholangiopancreatography one Nazca P which is a long word. So ercp you can do and MRCP. That’s where you use a magnetic resonance. Imaging you can do ultrasound you can do

Glen Geography. Okay, so that takes care of the cholestatic liver diseases and thanks for joining us.


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