gi Flashcards
1
Q
Compare and contrast primary sclerosing cholangitis, primary biliary cirrhosis, and secondary biliary cirrhosis.
A
Primary sclerosing cholangitis
- Idiopathic “onion skin” bile duct fibrosis; alternating strictures and dilatation (“beading”)
- Intra- and extrahepatic
- Hypergammaglobulinemia (IgM), associated with ulcerative colitis. May lead to 2BC. HLA-B27.
Primary biliary cirrhosis
- Autoimmune reaction leading to lymphocytic infiltrate and granulomas
- Serum anti-mitochondrial antibodies
- Associated with other autoimmune conditions, eg CREST, RA, Celiac, and Crohn’s.
Secondary biliary cirrhosis
- Extrahepatic obstruction (eg stone) causes intrahepatic bile duct injury.
- May present with ascending cholangitis
All present with
- Pruritus, jaundice, dark urine, light stools, hepatosplenomegaly
- Increased conjugated bilirubin, cholesterol, alkaline phosphatase, gamma-glutamyl transferase.
