okay so welcome to another MedCram lecture we're continuing our discussion
about actual diseases in terms of cholestatic liver diseases 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 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 who's itching and has some jaundiced or the Alfa's 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 ducts so this is
intra hepatic destruction of the biliary ducts 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 may actually also see a high cholesterol as we mentioned and the
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 gonna test you
on is you're gonna have positive auntie Myto
chondral antibodies that's the key positive anti mitochondrial antibodies
in more than 95% of the time you can diagnose this 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 hepatic now we're talking about both
intra and extra hepatic ductal problems it's associated with actually ulcerative
colitis okay so you think about those type of inflammatory diseases what
you're seeing here is fibrosis cholangitis 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 colon gia gram so you'll have this fibrosis here'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 colon Geograph okay so this beaded appearance
makes you think of sclerosing cholangitis and so the diagnosis is
actually a colon geo Clan geography if you will that means you just shoot dye
in there and you can see it light up it's pretty interesting to see that so
the beaded appearance is almost pathognomonic and it's associated with
these diseases and it looks very similar to primary biliary cirrhosis in terms of
labs so you get the elevated alq foss and you get this total bilirubin
elevation okay what about large bile duct obstruction again because out fossa
is an inducible enzyme you'll see that you also see increased T Billy here
however because you actually have a large bile duct obstruction this is
gonna look like gallbladder disease or cholecystitis you're gonna get pain
you're gonna get fever okay these type of things and the
diagnosis here again is you can do colon geography you can also do ultrasound you
could do an ERCP that's endoscopic retrograde cholangiopancreatography
which is a long word so II RCP you can do an mr c p that's reuse magnetic
resonance imaging you can do ultrasound you can do
clan geography okay so that takes care of the cholestatic liver diseases and
thanks for joining us