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17 Cards in this Set

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Cholestatic Liver Injury Labs
AP elevated 3-5 fold

Conjugated bilirubin increased

Aminotransferases elevated 2-3 fold only
Hepatocellular injury labs
Mild (2-5) fold elevation in AST and ALT in chronic viral hepatitis, steatohepatitis, metabolic disease

>10 fold elevation in viral hep, ischemia, drug induced hep
Primary Sclerosing Cholangitis Pathogenesis
Associated with Ulcerative Colitis more than Crohn;s disease

chronic cholestatic liver disease - inflammation and fibrosis of biliary tree -> biliary cirrhosis, portal htn
Primary Sclerosing Cholangitis Labs
AST,ALT < 5 times normal

AP increased

p-ANCA in 80%, ANA in 50-60%, SMA 35%
ERCP, MRCP
cholangiography used to diagnose primary sclerosing cholangitis

see multifocal stricturing
Primary Sclerosing Cholangitis histology
periductal fibrosis - concentric rings around bile duct "onion skin"

reduced number of bile ducts

ductular retraction

copper deposition (copper usually secreted into bile)
PSC vs PBC
PSC:
Cholestasis
intra OR extrahepatic
History of Colitis
AMA-
onion skin fibrosis
abnormal cholangiogram

PBC:
cholestasis
ONLY intrahepatic
NO history of colitis
AMA+
florid duct lesions
normal cholanngiogram
Primary Sclerosing Cholangitis complications
malabsorption of fat soluble vitamins

cholangiocarcinoma
primary biliary cirrhosis
chronic cholestatic disease
AMA+
destruction of bile ducts
Primary biliary cirrhosis labs
AP 3-4x normal

AST, ALT <200

elevated cholesterol

high IgM

Antimitochondrial antibody +
Primary biliary cirrhosis symptoms
pruritius

sicca syndrome (secondary Sjögren's syndrome) - keratoconjunctivitis, xerostomia)

xanthomata due to increased cholesterol level

thyroid disease, arthritis, scleroderma, raynauds, CREST possible
Usodiol (UDCA)
management of primary biliary cirrhosis
autoimmune hepatitis pathogeneisis
intermittent progressive inflammatory liver disease

high IgG autoantibodies

periportal hepatitis

type1 (50yo females): ANA+, SMA+

type 2 (young girls, does not respond to corticosteroids): liver kidney microsome 1 (LKM1) +

type 3: SLA/LP
autoimmune hepatitis treatment
corticosteroids - prednisone

azathrioprine - steroid sparing agent, takes along time to take effect
autoimmune hepatitis histology
lots of plasma cells

interface hepatitis

no biliary lesions, granulomas, steatosis
liver ultrasound showing diffuse bright hyperechoic pattern is indicative of
nonalchoholic fatty liver disease
nonalchoholic fatty liver disease pathogenesis
insulin resistance and incresaed oxidative stress impairs mitochondiral beta oxidation of fatty acids -> accumulation