Hepatomegaly Flashcards
1
Q
What is the epidemiology of primary biliary cholangitis
A
- Chronic disease of the small intrahepatic ducts, characterised by progressive bile duct damage (and eventual loss) occurring in the context of chronic portal tract inflammation.
- Fibrosis and secondary effects of retained bile acids
- Consequent cirrhosis
Female: Male 10:1
>45 yrs
2
Q
How does primary biliary cholangitis present
A
- Hx of hypercholesterolaemia
- Itch
- Fatigue
- Hepatomegaly
- Dry eyes and dry mouth - associated Sjogren’s
- Sleep disturbance
- Weight loss
- Jaundice
- Ascites
3
Q
What investigations may you order in suspected primary biliary cholangitis
A
Liver function tests
- Alk Phos - ++
- Gamma GT - +
- Bilirubin, albumin - + - suggestive of impaired synthetic ability of liver
- AST/ALT - +
Auto-antibodies
- Anti-mitochondrial antibody
- ANA
- ANCA
Imaging
- MRCP
4
Q
How do you manage primary biliary cholangitis
A
Ursodeoxycholic acid - bile acid analogue
- long term therapy
Immunomodulation e.g. prednisolone
Anti-pruritic - colestyramine
5
Q
What are some complications of primary sclerosing cholangitis
A
- Acute bacterial cholangitis
- Cholangiocarcinoma
- Colorectal cancer
- Cirrhosis and liver failure
- Fat soluble vitamin deficiency
