Key Biliary Tract / Cholestatic Diseases & Labs Explained


okay so welcome to another MedCram
lecture we’re continuing our discussion about actual diseases in terms of
cholestatic liver diseases so let’s go ahead to the table okay so here are
three major diseases we’ve got primary biliary cirrhosis
we’ve got primary sclerosing cholangitis and we’ve got large bile duct
obstruction let’s talk about primary biliary cirrhosis first in this area
we’ve got these categories alkaline phosphatase total bilirubin history and
diagnosis so primary biliary cirrhosis is more common in women it causes
fatigue and itching so think about a woman who’s itching and has some
jaundiced or the Alfa’s is going to be definitely elevated and that’s because
what this primary biliary cirrhosis is it’s like little portal granulomas so
little granulomas affecting the portal area and you get destruction of the
intrahepatic biliary ducts so this is intra hepatic destruction of the biliary
ducts we see this in middle-aged women and you do get an increase in
cholesterol retention it can be asymptomatic for years or even decades
so what you see is a high alkaline phosphatase you may actually also see a
high cholesterol as we mentioned and the the bilirubin does go up but it doesn’t
go up until later in the disease here’s the key though for the diagnosis okay
and this is what they’re gonna test you on is you’re gonna have positive
auntie Myto chondral antibodies that’s the key
positive anti mitochondrial antibodies in more than 95% of the time you can
diagnose this with liver biopsy okay so if you’ve got lady fits into this
category make sure you get an anti mitochondrial antibody okay let’s talk
about primary sclerosing cholangitis now with this whereas this was just
hepatic now we’re talking about both intra and extra hepatic ductal problems
it’s associated with actually ulcerative colitis okay so you think about those
type of inflammatory diseases what you’re seeing here is fibrosis
cholangitis of the biliary ducts and what you’ll see is kind of like a beads
on a string type of appearance if you were to do a colon gia gram so you’ll
have this fibrosis here’s the biliary duct and then you’ll have this fibrosis
fibrosis fibrosis so it looks like beads on a string if you were to do a colon
Geograph okay so this beaded appearance makes you think of sclerosing
cholangitis and so the diagnosis is actually a colon geo Clan geography if
you will that means you just shoot dye in there and you can see it light up
it’s pretty interesting to see that so the beaded appearance is almost
pathognomonic and it’s associated with these diseases and it looks very similar
to primary biliary cirrhosis in terms of labs so you get the elevated alq foss
and you get this total bilirubin elevation okay what about large bile
duct obstruction again because out fossa is an inducible enzyme you’ll see that
you also see increased T Billy here however because you actually have a
large bile duct obstruction this is gonna look like gallbladder disease or
cholecystitis you’re gonna get pain you’re gonna get fever
okay these type of things and the diagnosis here again is you can do colon
geography you can also do ultrasound you could do an ERCP that’s endoscopic
retrograde cholangiopancreatography which is a long word so II RCP you can
do an mr c p that’s reuse magnetic resonance imaging you can do ultrasound
you can do clan geography okay so that takes care
of the cholestatic liver diseases and thanks for joining us

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