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Cholestatic Liver Disease: Primary Biliary Cirrhosis vs Primary Sclerosing Cholangitis

#pathophysiology #pbc #psc #hepatology #comparison
Liver Disease: Primary ... Biliary Cirrhosis ... vs Primary Sclerosing ... pathophysiology #pbc ... #psc #hepatology
Primary Biliary Cirrhosis - Diagnosis Algorithm
Symptoms: Fatigue, Pruritus, Right upper quadrant discomfort
Signs: Jaundice, Xanthelasmata, Hepatomegaly
Associated history:
Primary Biliary ... Cirrhosis - Diagnosis ... #PBC #Primary ... #Biliary #Cirrhosis ... Diagnosis #Algorithm #hepatology
Primary Biliary Cirrhosis - Pathophysiology
Environmental Risk Factors: Geographic location, Smoking, Microbial triggers, Xenobiotics, Nail polish
Epigentics Risk
Primary Biliary ... Cirrhosis - Pathophysiology ... cell mediated autoimmune ... #Primary #Biliary ... #hepatology
Common Etiologies of Cirrhosis

Inflammation

 - Hepatitis B (15 percent)

 - Hepatitis C (47 percent)

 - Schistosomiasis
Etiologies of Cirrhosis ... Schistosomiasis - Autoimmune ... congenital - Primary ... biliary cirrhosis ... #Differential #Hepatology
Primary Biliary Cirrhosis (PBC) - Diagnosis Algorithm

#Primary #Biliary #Cirrhosis #PBC #Diagnosis #Algorithm #hepatology
Primary Biliary ... Cirrhosis (PBC) ... Algorithm #Primary ... #Biliary #Cirrhosis ... #Algorithm #hepatology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Malignant • Primary ... Hepatitis • Autoimmune ... Cholangitis • Primary ... Biliary Cirrhosis ... Algorithm #Causes #Hepatology
Primary Biliary Cirrhosis (PBC) - Summary

PBC Epidemiology:
 • Female:Male 9:1
 • Common European descent
 • Age:
Primary Biliary ... Cirrhosis (PBC) ... cholestasis → Cirrhosis ... #Biliary #Cirrhosis ... diagnosis #workup #hepatology
Bandemia Overview

Normal: < 1%
Clinically significant: > 10%

Band neutrophils are slightly less mature than segmented neutrophils and
on the left Myeloblast ... Corticosteroid use • Autoimmune ... Even with normal WBC ... 21% had normal WBC ... #CBC #hematology
Autoantibodies and their Disease Associations
ANA - Non-specific; common in SLE, autoimmune hepatitis
Anti-CCP, Rheumatoid factor - RA
Anti-dsDNA
common in SLE, autoimmune ... microsomal) - Autoimmune ... , Anti-gp210 - Primary ... biliary cirrhosis ... (PBC) Anticentromere
Diagnostic Framework for Hemolysis - Intravascular vs Extravascular Causes
Intravascular Hemolysis:
 • Mechanical Trauma (Microangiopathic hemolytic anemia):
Immune-mediated: - Autoimmune ... idiopathic) - Autoimmune ... usually IgM) (e.g. primary ... • Intrinsic RBC ... differential #diagnosis #hematology