Primary sclerosing cholangitis laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
The workup in patients with primary sclerosing cholangitis consists of [[LFTs]], [[Immunoglobulin|serum immunoglobulins]], as well as a number of [[autoantibodies]]. Patients with primary sclerosing cholangitis typically have an elevated level of [[ALP]], amongst other findings. However, laboratory results in many patients may be normal. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
The workup in patients with primary sclerosing cholangitis consists of [[LFTs]], [[serum immunoglobulins]], as well as a number of [[autoantibodies]]. Patients with primary sclerosing cholangitis typically have an elevated level of [[ALP]], amongst other findings. However, laboratory results in many patients may be normal.<ref name="pmid27653566">{{cite journal |vauthors=Lazaridis KN, LaRusso NF |title=Primary Sclerosing Cholangitis |journal=N. Engl. J. Med. |volume=375 |issue=12 |pages=1161–70 |year=2016 |pmid=27653566 |doi=10.1056/NEJMra1506330 |url=}}</ref><ref name="pmid20101749">{{cite journal |vauthors=Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ |title=Diagnosis and management of primary sclerosing cholangitis |journal=Hepatology |volume=51 |issue=2 |pages=660–78 |year=2010 |pmid=20101749 |doi=10.1002/hep.23294 |url=}}</ref><ref name="pmid7877651">{{cite journal |vauthors=Lee YM, Kaplan MM |title=Primary sclerosing cholangitis |journal=N. Engl. J. Med. |volume=332 |issue=14 |pages=924–33 |year=1995 |pmid=7877651 |doi=10.1056/NEJM199504063321406 |url=}}</ref><ref name="pmid10707856">{{cite journal |vauthors=Angulo P, Peter JB, Gershwin ME, DeSotel CK, Shoenfeld Y, Ahmed AE, Lindor KD |title=Serum autoantibodies in patients with primary sclerosing cholangitis |journal=J. Hepatol. |volume=32 |issue=2 |pages=182–7 |year=2000 |pmid=10707856 |doi= |url=}}</ref><ref name="pmid16879434">{{cite journal |vauthors=Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, Chari S, Lindor KD |title=Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis |journal=Am. J. Gastroenterol. |volume=101 |issue=9 |pages=2070–5 |year=2006 |pmid=16879434 |doi=10.1111/j.1572-0241.2006.00772.x |url=}}</ref><ref name="pmid16426597">{{cite journal |vauthors=Hirano K, Kawabe T, Yamamoto N, Nakai Y, Sasahira N, Tsujino T, Toda N, Isayama H, Tada M, Omata M |title=Serum IgG4 concentrations in pancreatic and biliary diseases |journal=Clin. Chim. Acta |volume=367 |issue=1-2 |pages=181–4 |year=2006 |pmid=16426597 |doi=10.1016/j.cca.2005.11.031 |url=}}</ref> | The workup in patients with primary sclerosing cholangitis consists of [[LFTs]], [[Immunoglobulins|serum immunoglobulins]], as well as a number of [[autoantibodies]]. Patients with primary sclerosing cholangitis typically have an elevated level of [[ALP]], amongst other findings. However, laboratory results in many patients may be normal.<ref name="pmid27653566">{{cite journal |vauthors=Lazaridis KN, LaRusso NF |title=Primary Sclerosing Cholangitis |journal=N. Engl. J. Med. |volume=375 |issue=12 |pages=1161–70 |year=2016 |pmid=27653566 |doi=10.1056/NEJMra1506330 |url=}}</ref><ref name="pmid20101749">{{cite journal |vauthors=Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ |title=Diagnosis and management of primary sclerosing cholangitis |journal=Hepatology |volume=51 |issue=2 |pages=660–78 |year=2010 |pmid=20101749 |doi=10.1002/hep.23294 |url=}}</ref><ref name="pmid7877651">{{cite journal |vauthors=Lee YM, Kaplan MM |title=Primary sclerosing cholangitis |journal=N. Engl. J. Med. |volume=332 |issue=14 |pages=924–33 |year=1995 |pmid=7877651 |doi=10.1056/NEJM199504063321406 |url=}}</ref><ref name="pmid10707856">{{cite journal |vauthors=Angulo P, Peter JB, Gershwin ME, DeSotel CK, Shoenfeld Y, Ahmed AE, Lindor KD |title=Serum autoantibodies in patients with primary sclerosing cholangitis |journal=J. Hepatol. |volume=32 |issue=2 |pages=182–7 |year=2000 |pmid=10707856 |doi= |url=}}</ref><ref name="pmid16879434">{{cite journal |vauthors=Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, Chari S, Lindor KD |title=Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis |journal=Am. J. Gastroenterol. |volume=101 |issue=9 |pages=2070–5 |year=2006 |pmid=16879434 |doi=10.1111/j.1572-0241.2006.00772.x |url=}}</ref><ref name="pmid16426597">{{cite journal |vauthors=Hirano K, Kawabe T, Yamamoto N, Nakai Y, Sasahira N, Tsujino T, Toda N, Isayama H, Tada M, Omata M |title=Serum IgG4 concentrations in pancreatic and biliary diseases |journal=Clin. Chim. Acta |volume=367 |issue=1-2 |pages=181–4 |year=2006 |pmid=16426597 |doi=10.1016/j.cca.2005.11.031 |url=}}</ref> | ||
===Liver Function Tests=== | ===Liver Function Tests=== | ||
Primary sclerosing cholangitis typically has a cholestatic clinical picture with elevation of [[ALP]], and [[aminotransferases]] ([[AST]] and [[ALT]]) may be elevated to 2-3 times of the upper normal level. However, [[LFTs]] may be normal. | Primary sclerosing cholangitis typically has a [[cholestatic]] clinical picture with elevation of [[ALP]], and [[aminotransferases]] ([[AST]] and [[ALT]]) may be elevated to 2-3 times of the upper normal level. However, [[LFTs]] may be normal. | ||
===Immunoglobulins=== | ===Immunoglobulins=== | ||
| Line 22: | Line 23: | ||
*[[Anti-neutrophil cytoplasmic antibody]] ([[p-ANCA]]) | *[[Anti-neutrophil cytoplasmic antibody]] ([[p-ANCA]]) | ||
*[[Anti-nuclear antibody]] ([[ANA]]) | *[[Anti-nuclear antibody]] ([[ANA]]) | ||
*[[Anti-smooth muscle antibody]] (Anti-Sm) | *[[Anti-smooth muscle antibody]] ([[Anti smooth muscle antibody|Anti-Sm]]) | ||
*Anti-endothelial antibody | *Anti-endothelial antibody | ||
*Anti-cardiolipin antibody | *[[Anti-cardiolipin antibodies|Anti-cardiolipin antibody]] | ||
*[[Thyroperoxidase]] | *[[Thyroperoxidase]] | ||
*[[Thyroglobulin]] | *[[Thyroglobulin]] | ||
Latest revision as of 16:31, 6 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
The workup in patients with primary sclerosing cholangitis consists of LFTs, serum immunoglobulins, as well as a number of autoantibodies. Patients with primary sclerosing cholangitis typically have an elevated level of ALP, amongst other findings. However, laboratory results in many patients may be normal.
Laboratory Findings
The workup in patients with primary sclerosing cholangitis consists of LFTs, serum immunoglobulins, as well as a number of autoantibodies. Patients with primary sclerosing cholangitis typically have an elevated level of ALP, amongst other findings. However, laboratory results in many patients may be normal.[1][2][3][4][5][6]
Liver Function Tests
Primary sclerosing cholangitis typically has a cholestatic clinical picture with elevation of ALP, and aminotransferases (AST and ALT) may be elevated to 2-3 times of the upper normal level. However, LFTs may be normal.
Immunoglobulins
- Hypergammaglobulinemia
- Elevated IgM levels
- Elevated IgG4 levels
Autoantibodies and Serology
One or more of the following autoantibodies may be present in patients with primary sclerosing cholangitis:
- Anti-neutrophil cytoplasmic antibody (p-ANCA)
- Anti-nuclear antibody (ANA)
- Anti-smooth muscle antibody (Anti-Sm)
- Anti-endothelial antibody
- Anti-cardiolipin antibody
- Thyroperoxidase
- Thyroglobulin
- Rheumatoid factor (RF)
References
- ↑ Lazaridis KN, LaRusso NF (2016). "Primary Sclerosing Cholangitis". N. Engl. J. Med. 375 (12): 1161–70. doi:10.1056/NEJMra1506330. PMID 27653566.
- ↑ Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ (2010). "Diagnosis and management of primary sclerosing cholangitis". Hepatology. 51 (2): 660–78. doi:10.1002/hep.23294. PMID 20101749.
- ↑ Lee YM, Kaplan MM (1995). "Primary sclerosing cholangitis". N. Engl. J. Med. 332 (14): 924–33. doi:10.1056/NEJM199504063321406. PMID 7877651.
- ↑ Angulo P, Peter JB, Gershwin ME, DeSotel CK, Shoenfeld Y, Ahmed AE, Lindor KD (2000). "Serum autoantibodies in patients with primary sclerosing cholangitis". J. Hepatol. 32 (2): 182–7. PMID 10707856.
- ↑ Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, Chari S, Lindor KD (2006). "Elevated serum IgG4 concentration in patients with primary sclerosing cholangitis". Am. J. Gastroenterol. 101 (9): 2070–5. doi:10.1111/j.1572-0241.2006.00772.x. PMID 16879434.
- ↑ Hirano K, Kawabe T, Yamamoto N, Nakai Y, Sasahira N, Tsujino T, Toda N, Isayama H, Tada M, Omata M (2006). "Serum IgG4 concentrations in pancreatic and biliary diseases". Clin. Chim. Acta. 367 (1–2): 181–4. doi:10.1016/j.cca.2005.11.031. PMID 16426597.