Biliary tract

Question 1

What is the pathology and classical presentation of prmary biliary cholangitis?

Answer 1

This is an autoimmune granulomatous inflammation of the biliary tract
It typically is asymptomatic with raised ALP found coincidentaly
Lethargy, jaundice, pruritis and sleepiness, Skin pigmentation

Question 2

What investigaions should be done for primary biliary cholangitis?

Answer 2

Should do bloods: LFTs show increased ALP and gamma GT, slightly raised AST and ALT
Late disease shows increased bilirubin, decreased albumin and increased prothrombin time
There will be antimitochondrial antibody present on bloods
Ultrasound of bile duct can be used to rule out extrahepatic cholestasis

Question 3

What is the treatment of primary biliary cholangitis?

Answer 3

Symptomatic treatment for pruritis can be used:
-Colestyramine
Codiene phosphate for diarrhoea
Bisphosphonates for osteoporosis
Fat soluable vitamin prophylaxis of vit A, D and K
Liver transplant for end stage disease

Question 4

What are the signs and symptoms of primary sclerosing cholangitis?

Answer 4

Pruritis with fatigue

If advanced then cholangitis, cirrhosis and hepatic failure

Question 5

What is the treatment of primary sclerosing cholangitis?

Answer 5

It is treated with liver transplant for end stage disease

Colestyramine for pruritis