Dr. Michael Chew @mchew85
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GrepMed Gastroenterology-Hepatology Editor, Academic Hospitalist UC Davis Medical Center Internal Medicine, Yale Gastroenterology Fellow '22
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Primary Biliary Cirrhosis - Diagnosis Algorithm
Symptoms: Fatigue, Pruritus, Right upper quadrant discomfort
Signs: Jaundice, Xanthelasmata, Hepatomegaly
Associated history:
Primary Biliary ... Cirrhosis - Diagnosis ... consistent with PBC ... #PBC #Primary ... #Biliary #Cirrhosis
Primary Biliary Cirrhosis - Pathophysiology
Environmental Risk Factors: Geographic location, Smoking, Microbial triggers, Xenobiotics, Nail polish
Epigentics Risk
Primary Biliary ... Cirrhosis - Pathophysiology ... relative with PBC ... Cholestasis #PBC ... #Cirrhosis #Pathophysiology
Primary Biliary Cirrhosis (PBC) - Diagnosis Algorithm

#Primary #Biliary #Cirrhosis #PBC #Diagnosis #Algorithm #hepatology
Primary Biliary ... Cirrhosis (PBC) ... Algorithm #Primary #Biliary ... #Cirrhosis #PBC
Common Etiologies of Cirrhosis

Inflammation

 - Hepatitis B (15 percent)

 - Hepatitis C (47 percent)

 - Schistosomiasis
Etiologies of Cirrhosis ... congenital - Primary biliary ... cirrhosis - α1 ... #Diagnosis #Differential ... #Hepatology #Cirrhosis
Difficult Selective Biliary Cannulation (SBC)
Factors associated with difficult SBC:
 - SMALL PAPILLA: can be difficult to
Difficult Selective Biliary ... Cannulation (SBC ... site - OTHERS: biliary ... #Selective #Biliary ... Difficult #ercp #gastroenterology
Abnormal liver function tests algorithm.
 This figure details the initial response to abnormal liver blood tests.
Abnormal liver function ... initial response to abnormal ... include extrahepatic biliary ... body mass index; FBC ... Liver #Enzymes #Differential
Primary Biliary Cirrhosis - Management
A. Initiate therapy 
 - Initiate 1st line therapy with UDCA (13-15
Primary Biliary ... Cirrhosis - Management ... 1.5x ULN and/or abnormal ... survey disease #PBC ... #Primary #Biliary
Hepatitis B - Treatment Indications
Treatment not indicated:
 • Immune tolerant state - HBe-Ag detectable, high HBV
(>10^6 IU/mL), normal ... (<2000 IU/mL), normal ... Presence of CP or PC ... Family history of cirrhosis ... or fibrosis • Cirrhosis
Algorithm regarding the diagnosis and treatment of Hereditary Hemochromatosis HH. 

Step 1: In the patient with
<45% and SF is normal ... Patients with cirrhosis ... management #hepatology #gastroenterology
Antibiotic Prophylaxis for Endoscopy (ASGE 2015) 

Give Antibiotics: 
 - PEG tube placement (or PEG-J)
or PEG-J) - Cirrhosis ... mediastinal cysts - Biliary ... GI tract) - Biliary ... #Indications #Gastroenterology