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Cholestatic Liver Disease: Primary Biliary Cirrhosis vs Primary Sclerosing Cholangitis

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

PBC Epidemiology:
 • Female:Male 9:1
 • Common European descent
 • Age:
Cirrhosis (PBC) ... /Liver failure ... #Cirrhosis #PBC ... cholangitis #diagnosis #workup ... #hepatology
Primary Biliary Cirrhosis - Diagnosis Algorithm
Symptoms: Fatigue, Pruritus, Right upper quadrant discomfort
Signs: Jaundice, Xanthelasmata, Hepatomegaly
Associated history:
Primary Biliary ... Cirrhosis - Diagnosis ... Liver biopsy findings ... #Biliary #Cirrhosis ... Diagnosis #Algorithm #hepatology
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Autoimmune hepatitis, PBC ... stone, Malignancy, PBC ... hepatitis: < 1 • Cirrhosis ... (hemolysis) • ... diagnosis #algorithm #hepatology
Red Blood Cell (RBC) Morphology
Microcytic RBC: Pyridoxine deficiency, Thalassemia, Iron deficiency anemia, Chronic disease anemia (sometimes),
: Vitamin B12 or ... Microangiopathic Hemolytic ... spherocytosis, Autoimmune hemolytic ... Cold autoimmune hemolytic ... differential #diagnosis #hematology
Algorithmic Approach to Anemia - Differential Diagnosis Framework by MCV

Microcytic (MCV < 80) "TAILS":
 • Thalassemia
Spherocytosis, G6PD, PK, HbC ... Folate deficiency, B12 ... Non-megaloblastic: Liver ... disease, Alcoholism ... Differential #Diagnosis #hematology
The 6 C’s of Primary Sclerosing Cholangitis (PSC)
PSC is a chronic, cholestatic, immune-mediated disease characterized by
to multi-focal biliary ... • CIRRHOSIS - ... indications for liver ... colorectal and hepato-biliary ... management #summary #Hepatology
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
Elevated Liver Enzymes ... • Cholestatic disease ... Infiltrative • Cirrhosis ... Duct Stone • Biliary ... Others #LFTs #Hepatology
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
of cholestatic disease ... disease: > 2 ... hepatitis: < 1 • Cirrhosis ... (hemolysis) • ... #differential #Hepatology
Primary Biliary Cirrhosis - Management
A. Initiate therapy 
 - Initiate 1st line therapy with UDCA (13-15
Stage & survey disease ... #PBC #Primary ... #Biliary #Cirrhosis ... #Management #Treatment ... #hepatology