Primary biliary cirrhosis diagnostic study of choice: Difference between revisions

	Primary Biliary Cirrhosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Primary Biliary Cirrhosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
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 biliary cirrhosis diagnostic study of choice On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Primary biliary cirrhosis diagnostic study of choice All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Primary biliary cirrhosis diagnostic study of choice
CDC on Primary biliary cirrhosis diagnostic study of choice
Primary biliary cirrhosis diagnostic study of choice in the news
Blogs on Primary biliary cirrhosis diagnostic study of choice
Directions to Hospitals Treating Primary biliary cirrhosis
Risk calculators and risk factors for Primary biliary cirrhosis diagnostic study of choice

VisualWikitext

Latest revision as of 23:49, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2], Aysha Anwar, M.B.B.S [3]

Overview

Anti-mitochondrial antibody (AMA) titer is the diagnostic study of choice for the diagnosis of primary biliary cirrhosis. The diagnosis of primary biliary cirrhosis is made in the absence of extrahepatic biliary obstruction, no other comorbid condition affecting the liver with the presence of at least two of the criteria including an alkaline phosphatase 1.5 times the upper limit of normal, anti-mitochondrial antibodies with titer 1:40 or higher, and histology of liver demonstrating primary biliary cirrhosis.

Diagnostic Study of Choice

Anti-mitochondrial antibody (AMA) titer is the diagnostic study of choice for the diagnosis of primary biliary cirrhosis.^[1]^[2]
A titer of > 1:40 is suggestive of primary biliary cirrhosis.

Test	Sensitivity	Specificity
AMA titer	95%	98%

Diagnostic Criteria

The diagnosis of primary biliary cirrhosis is made in the absence of extrahepatic biliary obstruction, no other comorbid condition affecting the liver with the presence of at least two of the following:^[3]

An alkaline phosphatase 1.5 times the upper limit of normal
Anti-mitochondrial antibodies with titer 1:40 or higher
Histology of liver demonstrating primary biliary cirrhosis

Diagnostic Algorithm

Algorithm showing Diagnostic approach for primary biliary cirrhosis^[4]

Abnormal ALP

Confirm if the ALP is of liver origin

Abnormal GGT and/or total bilirubin and/or total cholesterol

Drug history

Yes

No

Discontiue drug and observe

Ultrasound

Normal bile ducts

Dilated bile duct(s)

Pattern suggestive of infiltration

AMA postitve

AMA negative

Focal lesions

Biopsy^*

Probable PBC

No

Yes

Confirmation of disease and histological stage

CT and/or MRI

Biopsy

IHBD stone

Liver neoplasm

Ocassional AIH

Definite PBC

MRCP

Biopsy

Normal

Strictures

Biopsy

PSC
SSC

PBC

Cholestasis
Small duct PSC
VBDS

^*Infiltration into liver
e.g.: Malignant lymphoma

ABBREVIATIONS: AIH - Autoimmune hepatitis; ALP; Alkaline phosphatase; AMA - Antimitochondrial antibody; CT - Computed tomography; GGT - Gamma-glutamyl transpeptidase; IHBD - Intrahepatic bile duct; MRCP - Magnetic resonance cholangiopancreatography; MRI - Magnetic resonance imaging; PBC - Primary biliary cirrhosis; PSC - Primary sclerosing cholangitis; SSC - Secondary sclerosing cholangitis; VBDS - Vanishing bile duct syndrome

References

↑ Muratori L, Granito A, Muratori P, Pappas G, Bianchi FB (2008). "Antimitochondrial antibodies and other antibodies in primary biliary cirrhosis: diagnostic and prognostic value". Clin Liver Dis. 12 (2): 261–76, vii. doi:10.1016/j.cld.2008.02.009. PMID 18456179.
↑ WALKER JG, DONIACH D, ROITT IM, SHERLOCK S (1965). "SEROLOGICAL TESTS IN DIAGNOSIS OF PRIMARY BILIARY CIRRHOSIS". Lancet. 1 (7390): 827–31. PMID 14263538.
↑ Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ; et al. (2009). "Primary biliary cirrhosis". Hepatology. 50 (1): 291–308. doi:10.1002/hep.22906. PMID 19554543.
↑ Kumagi T, Heathcote EJ (2008). "Primary biliary cirrhosis". Orphanet J Rare Dis. 3: 1. doi:10.1186/1750-1172-3-1. PMC 2266722. PMID 18215315.

Template:WH Template:WS

[pmid18456179-1] Muratori L, Granito A, Muratori P, Pappas G, Bianchi FB (2008). "Antimitochondrial antibodies and other antibodies in primary biliary cirrhosis: diagnostic and prognostic value". Clin Liver Dis. 12 (2): 261–76, vii. doi:10.1016/j.cld.2008.02.009. PMID 18456179.

[pmid14263538-2] WALKER JG, DONIACH D, ROITT IM, SHERLOCK S (1965). "SEROLOGICAL TESTS IN DIAGNOSIS OF PRIMARY BILIARY CIRRHOSIS". Lancet. 1 (7390): 827–31. PMID 14263538.

[pmid19554543-3] Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ; et al. (2009). "Primary biliary cirrhosis". Hepatology. 50 (1): 291–308. doi:10.1002/hep.22906. PMID 19554543.

[pmid18215315-4] Kumagi T, Heathcote EJ (2008). "Primary biliary cirrhosis". Orphanet J Rare Dis. 3: 1. doi:10.1186/1750-1172-3-1. PMC 2266722. PMID 18215315.

[1]

[2]

[3]

[4]

@@ Line 2: / Line 2: @@
 {{Primary biliary cirrhosis}}
-{{CMG}}; {{AE}} {{AA}}
+{{CMG}}; {{AE}} {{Anmol}}, {{AA}}
 ==Overview==
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
+[[Anti-mitochondrial antibody]] (AMA) titer is the diagnostic study of choice for the diagnosis of primary biliary cirrhosis. The diagnosis of primary biliary cirrhosis is made in the absence of extrahepatic [[biliary obstruction]], no other comorbid condition affecting the [[liver]] with the presence of at least two of the criteria including an [[alkaline phosphatase]] 1.5 times the upper limit of normal, [[Anti-mitochondrial antibody|anti-mitochondrial antibodies]] with titer 1:40 or higher, and histology of liver demonstrating primary biliary cirrhosis.
-OR
+==Diagnostic Study of Choice==
+*[[Anti-mitochondrial antibody]] (AMA) titer is the diagnostic study of choice for the diagnosis of primary biliary cirrhosis.<ref name="pmid18456179">{{cite journal| author=Muratori L, Granito A, Muratori P, Pappas G, Bianchi FB| title=Antimitochondrial antibodies and other antibodies in primary biliary cirrhosis: diagnostic and prognostic value. | journal=Clin Liver Dis | year= 2008 | volume= 12 | issue= 2 | pages= 261-76; vii | pmid=18456179 | doi=10.1016/j.cld.2008.02.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18456179  }} </ref><ref name="pmid14263538">{{cite journal| author=WALKER JG, DONIACH D, ROITT IM, SHERLOCK S| title=SEROLOGICAL TESTS IN DIAGNOSIS OF PRIMARY BILIARY CIRRHOSIS. | journal=Lancet | year= 1965 | volume= 1 | issue= 7390 | pages= 827-31 | pmid=14263538 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14263538  }} </ref>
+*A titer of > 1:40 is suggestive of primary biliary cirrhosis.
+{|
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Test
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
+|-
+! style="background: #696969; color: #FFFFFF; text-align: center;" |AMA titer
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |95%
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |98%
+|}
 ==Diagnostic Criteria==
-The diagnosis of primary biliary cirrhosis is made in the absence of extrahepatic biliary obstruction, no other comorbid condition affecting the liver with the presence of atleast two of the following:
+The diagnosis of primary biliary cirrhosis is made in the absence of extrahepatic [[biliary obstruction]], no other comorbid condition affecting the [[liver]] with the presence of at least two of the following:<ref name="pmid19554543">{{cite journal| author=Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ et al.| title=Primary biliary cirrhosis. | journal=Hepatology | year= 2009 | volume= 50 | issue= 1 | pages= 291-308 | pmid=19554543 | doi=10.1002/hep.22906 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19554543  }} </ref>
-**An alkaline phosphatase 1.5 times the upper limit of normal
+*An [[alkaline phosphatase]] 1.5 times the upper limit of normal
-**Anti mitochondrial antibodies with titre 1:40 or higher
+*[[Anti-mitochondrial antibody|Anti-mitochondrial antibodies]] with titer 1:40 or higher
-**Histology of liver demonstrating primary biliary cirrhosis
+*Histology of liver demonstrating primary biliary cirrhosis
+==Diagnostic Algorithm==
+<div style="text-align: center;">'''Algorithm showing Diagnostic approach for primary biliary cirrhosis'''<ref name="pmid18215315">{{cite journal| author=Kumagi T, Heathcote EJ| title=Primary biliary cirrhosis. | journal=Orphanet J Rare Dis | year= 2008 | volume= 3 | issue=  | pages= 1 | pmid=18215315 | doi=10.1186/1750-1172-3-1 | pmc=2266722 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18215315  }} </ref></div>
+<br>
+{{Family tree/start}}
+{{Family tree | | | | | | | | | A01 | | | | | | | | A01=Abnormal [[ALP]]}}
+{{Family tree | | | | | | | | | |!| | | | | | | | | }}
+{{Family tree | | | | | | | | | B01 | | | | | | | | B01=Confirm if the [[ALP]] is of [[liver]] origin}}
+{{Family tree | | | | | | | | | |!| | | | | | | | | }}
+{{Family tree | | | | | | | | | C01 | | | | | | | | C01=Abnormal [[GGT]] and/or total [[bilirubin]] and/or total [[cholesterol]]}}
+{{Family tree | | | | | | | | | |!| | | | | | | | | }}
+{{Family tree | | | | | | | | | D01 | | | | | | | | D01=Drug history}}
+{{Family tree | | | | |,|-|-|-|-|^|-|-|-|-|.| | | | }}
+{{Family tree | | | | E01 | | | | | | | | E02 | | | E01=Yes | E02=No}}
+{{Family tree | | | | |!| | | | | | | | | |!| | | | }}
+{{Family tree | | | | F01 | | | | | | | | F02 | | | F01=Discontiue drug and observe | F02=[[Ultrasound]]}}
+{{Family tree | | | | | | | | | | | | | | |!| | | | }}
+{{Family tree | | | | | | |,|-|-|-|-|v|-|-|^|-|.| | | | }}
+{{Family tree | | | | | | G01 | | | G02 | | | G03 | G01=Normal [[bile duct]]s| G02=Dilated [[bile duct]](s)| G03=Pattern suggestive of infiltration}}
+{{Family tree | | | |,|-|-|^|.| | | |!| | | | |!| | }}
+{{Family tree | | | H01 | | H02 | | H03 | | | H04 | H01=[[AMA]] postitve| H02=[[AMA]] negative| H03=Focal lesions| H04=[[Biopsy]]<sup>*</sup>}}
+{{Family tree | | | |!| | | |!| |,|-|^|-|.| | | | |}}
+{{Family tree | | | I01 | | |!| I02 | | I03 | | | | I01=Probable [[PBC]]| I02=No| I03=Yes}}
+{{Family tree | | | |!| | | |!| |!| | | |!| | | | |}}
+{{Family tree | | | J01 | | |!| |!| | | J02 | | | |J01=Confirmation of disease and histological stage| J02=[[CT]] and/or [[MRI]]}}
+{{Family tree | | | |!| | | |!| |!| |,|-|^|-|.| | | }}
+{{Family tree | | | K01 | | |!| |!| K02 | | K03 | K01=[[Biopsy]]| K02=IHBD stone| K03=[[Liver neoplasm]]}}
+{{Family tree | | | |!| | | |`|.|!|,|'| | | |!| }}
+{{Family tree | |,|-|^|-|.| | |!|!|!| | | | |!| |}}
+{{Family tree | L01 | | L02 | | L03 | | | | L04 | L01=Ocassional AIH| L02=Definite PBC| L03=MRCP| L04=Biopsy}}
+{{Family tree | | | | | | | |,|-|^|-|.| | | | | }}
+{{Family tree | | | | | | | M01 | | M02 | | | M01=Normal| M02=Strictures}}
+{{Family tree | | | | | | | |!| | | |!| | | | }}
+{{Family tree | | | | | | | N01 | | N02 | | | N01=[[Biopsy]]| N02=[[PSC]]<br>SSC}}
+{{Family tree | | | |,|-|-|-|+|-|-|-|.| | | | | }}
+{{Family tree | | | P01 | | P02 | | P03 | | | | P01=[[PBC]]| P02=[[Cholestasis]]<br>Small duct [[PSC]]<br>VBDS| P03=<sup>*</sup>Infiltration into [[liver]]<br>e.g.: Malignant lymphoma }}
+{{Family tree/end}}
+<small>'''ABBREVIATIONS: AIH - Autoimmune hepatitis; ALP; Alkaline phosphatase; AMA - Antimitochondrial antibody; CT - Computed tomography; GGT - Gamma-glutamyl transpeptidase; IHBD - Intrahepatic bile duct; MRCP - Magnetic resonance cholangiopancreatography; MRI - Magnetic resonance imaging; PBC - Primary biliary cirrhosis; PSC - Primary sclerosing cholangitis; SSC - Secondary sclerosing cholangitis; VBDS - Vanishing bile duct syndrome'''</small>
 ==References==
@@ Line 19: / Line 74: @@
 {{WH}}
 {{WS}}
+[[Category:Gastroenterology]]
+[[Category:Hepatology]]
+[[Category:Disease]]
+[[Category:Rheumatology]]
+[[Category:Medicine]]
+[[Category:Up-To-Date]]

Primary biliary cirrhosis diagnostic study of choice: Difference between revisions

Latest revision as of 23:49, 29 July 2020

Overview

Diagnostic Study of Choice

Diagnostic Criteria

Diagnostic Algorithm

References

Navigation menu