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 skill Rowson
cholangitis and we've got large bile
duct obstruction let's talk about
primary biliary cirrhosis first in this
area we've got these 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 alpha is going to be
definitely elevated and that's because
what this primary biliary cirrhosis is
what they are is 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 going to test you on is you're
going to have positive auntie my toe
con drill 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 who 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
intro 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 jia
gram so you'll have this fibrosis here's
the biliary duct and then you'll have
this fibrosis fibrosis eyebro --ss 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 k-- Cola NGO
clan geography if you will that means
you just shoot dye in there and you can
see it light up it's pretty 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 alpha 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 going to 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 could also do ultrasound
and you could do ercp that's endoscopic
retrograde cholangiopancreatography
which is a long word so ii RCP you can
do an mr c p that's where you use a
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
you
