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Cholestatic Liver Disease: Primary Biliary Cirrhosis vs Primary Sclerosing Cholangitis

#pathophysiology #pbc #psc #hepatology #comparison
Cholestatic Liver ... pathophysiology #pbc ... #psc #hepatology
Primary Biliary Cirrhosis (PBC) - Summary

PBC Epidemiology:
 • Female:Male 9:1
 • Common European descent
 • Age:
Biliary Cirrhosis (PBC ... ) - Summary PBC ... bile ducts causes cholestasis ... , Intrahepatic cholestasis ... , Drug-induced cholestasis
Abnormal Liver Function Tests - Differential Diagnosis Algorithm for Transaminitis
Hepatocellular Pattern (ALT or AST > ALP):
def, Wilson's, Cholestatic ... dz Cholestatic ... Ducts - PBC ... , PSC, Alcoholic ... Biliary stricture, PSC
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
poisoning, ETOH Cholestatic ... stone, Malignancy, PBC ... elevation Labs in Cholestatic ... epithelia: - Cholestasis ... ALT: typical of cholestatic
Causes of Acute Liver Injury - Differential Diagnosis
Hepatocellular - Liver Parenchyma
 • Infectious: Hepatitis C, A,
Thrombus, Vasospasm Cholestatic ... Malignancy, 1° PBC ... , 1° PSC, Cystic ... Hepatitis, TB Cholestatic
Primary Biliary Cirrhosis - Pathophysiology
Environmental Risk Factors: Geographic location, Smoking, Microbial triggers, Xenobiotics, Nail polish
Epigentics Risk
relative with PBC ... biliary fibrosis - Cholestasis ... #PBC #Primary
Alkaline Phosphatase (ALP) Elevation - Differential Diagnosis Algorithm

ALP:
 - Enzymes that catalyze hydrolysis of organic phosphate
of Intrahepatic cholestasis ... - Pruritis - Cholestasis ... biliary Cholangitis (PBC ... Infiltrative diseases - PSC
Causes of Fat Malabsorption - Differential Diagnosis
Biliary Duct Obstruction
 • Autoimmune— PBC, PSC
 • Infection— liver
• Autoimmune— PBC ... , PSC • Infection ... amyloidosis Other: • Cholestatic
Autoimmune Hepatitis

Clinical Presentation
 - Highly variable clinical presentation, from subclinical disease to acute liver failure.
 -
injury, though cholestatic ... reported (eg AIH-PBC
Classification of Jaundice
Unconjugated hyperbilirubinemia (predominantly indirect bilirubin)
 • Increased bilirubin production (eg, hemolytic anemias, hemolytic reactions,
• Hereditary Cholestatic ... familial intrahepatic cholestasis ... of intrahepatic cholestasis ... ) Intrahepatic cholestasis ... or intrahepatic cholestasis