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Mechanism of Action of Bile Acid Sequestrants
Bile Acid Sequestrants → ↓ Hepatic Bile Acid Pool →
Mechanism of Action of Bile ... Sequestrants Bile ... Sequestrants → ↓ Hepatic Bile ... Pool → ↑ Hepatic Bile ... sequestration #pathophysiology
Biochemistry and Metabolism of Bilirubin
Hemolysis → Hemoglobin → Heme → Biliverdin → Unconjugated Bilirubin (a.k.a. "indirect
Excreted into bile ... ducts and common bile ... Biochemistry #Metabolism #pathophysiology
Primary Biliary Cirrhosis - Pathophysiology
Environmental Risk Factors: Geographic location, Smoking, Microbial triggers, Xenobiotics, Nail polish
Epigentics Risk
Biliary Cirrhosis - Pathophysiology ... relative with PBC Pathophysiology ... gradual loss of bile ... Biliary #Cirrhosis #Pathophysiology
Liver Chemistry Tests - AST, ALT, Alkaline Phosphatase and Bilirubin Metabolism
AST and ALT:
 • AST: liver
membrane (NOT within bile ... stimulated by bile ... bilirubin into bile ... Bilirubin #Hepatology #Pathophysiology
Primary Biliary Cirrhosis (PBC) - Summary

PBC Epidemiology:
 • Female:Male 9:1
 • Common European descent
 • Age:
65 years PBC Pathophysiology ... small intralobular bile ... of intralobular bile ... of interlobular bile ... related disease, Bile
Lipoprotein Metabolism

Enterocytes release absorbed lipids the form of triglyceride-rich chylomicrons. These are acted upon by endothelial
lipoproteins (VLDLs) and bile ... Cholesterol #Metabolism #Pathophysiology
Liver Function Test (LFTs) Elevation
AST - Cardiac and skeletal muscle, kidney, brain
ALT - More specific for
Biliary tree or bile ... abnormality vs bone Bili
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
disease US — Normal Bile ... US - Dilated Bile ... Ducts • Common Bile
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
ALP - Surface of bile ... - Cholestasis/Bile ... Unconjugated Bili ... > 90% of Total Bili
Bile acids are the end products of cholesterol catabolism. Cholic acid and chenodeoxycholic acid are the
Bile acids are the ... major primary bile ... secretion into bile ... 200 to 600 mg bile ... 5% of a total bile