Primary sclerosing cholangitis secondary prevention

Primary sclerosing cholangitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Primary sclerosing cholangitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Primary sclerosing cholangitis secondary prevention On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Primary sclerosing cholangitis secondary prevention All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Primary sclerosing cholangitis secondary prevention
CDC on Primary sclerosing cholangitis secondary prevention
Primary sclerosing cholangitis secondary prevention in the news
Blogs on Primary sclerosing cholangitis secondary prevention
Directions to Hospitals Treating Primary sclerosing cholangitis
Risk calculators and risk factors for Primary sclerosing cholangitis secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include screening for complications of liver cirrhosis, screening for colon and gallbladder cancers, as well as metabolic bone disease.

Secondary Prevention

Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include:

Complications/ Coexisting Conditions	Presentation	Screening	Management
Liver Cirrhosis	Esophageal varices, gastric varices Hepatocellular carcinoma (HCC)	Screen for varices by an esophagogastroduodenoscopy (EGD). Repeat every 2-3 years. Screen for HCC using an annual abdominal ultrasound with or without measuring alpha fetoprotein (AFP) levels.	If there are no varices, observe the patient and continue screening with repeat EGD. For small varices, treat with nadolol (40 mg, given once daily at bedtime). For large varices, treat with ligation. HCC: HCC is treated with ablation, resection or liver transplantation.
Gallbladder disease	Polyps/ masses	Abdominal ultrasound	Consider prophylactic cholecystectomy in patients with gallbladder polyps and masses, due to high risk of carcinoma. Chemotherapy is added if there is evidence of gallbladder cancer extending beyond the wall of the gallbladder.
IBD and associated risk of colon cancer	Colon cancer	Colonoscopy annually	In case of colon cancer, treat with colectomy. Chemotherapy is added to treatment regimen according to guidelines of the treatment of colon cancer.
Metabolic bone disease	Osteopenia/ osteoporosis	DEXA scan. Repeat every 2-3 years.	For osteopenia and osteoporosis, treat with calcium 1.0-1.5 g/day and vitamin D of 1,000 IU/day. Add bisphosphonates in the case of osteoporosis.

References

Template:WS Template:WH