Gastroenterology - Hepatology

Question 1

PSC vs PBC

Answer 1

Primary sclerosising cholangitis
- affects men more than women 3:2
- associated with inflammatory bowel disease
- diagnosed on MRCP
- urso helps with LFTs but not proven to slow disease progression
- associated with increased risk of colon cancer and biliary cancer - needs yearly colonoscopy

Primary biliary cirrhosis/cholangitis
- usually affects women more than men. 9:1
- associated with sjogren’s, sicca, coeliac, thyroid disorders
- diagnosed with positive anti mitochondrial antibody test and high ALP.
- treated with urso with improved prognosis
- associated with smoking

Question 2

Indications of surveillance for HCC in HBV with 6 monthly USS

Answer 2

1. Cirrhosis
2. Black patients >20 years old
3. Asian men >40 years and Asian women >50 years
4. High ALT levels and high HBV DNA levels >10,000
5. Family history of HCC