Primary biliary cirrhosis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Primary biliary cirrhosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Primary_biliary_cirrhosis]]


{{CMG}}; {{AE}} {{Anmol}}, {{MJ}}
{{CMG}}; {{AE}} {{MJ}}, {{Anmol}}


==Overview==
==Overview==
Primary biliary cirrhosis must be differentiated from other disease that may cause [[cholestasis]] including [[autoimmune hepatitis]], [[common bile duct]] stone, [[hepatitis A]] ([[choelstatic]] type), [[EBV]] or [[CMV]] [[hepatitis]], [[primary sclerosing cholangitis]], pre-ampullary cancers, [[AIDS]] cholangiopathy, [[parasites]] induced [[cholestasis]], and [[intrahepatic cholestasis of pregnancy]].


==Differentiating primary biliary cirrhosis from other Diseases==
==Differentiating primary biliary cirrhosis from other Diseases==
Primart biliary cirrhosis must be differentiated from other disease that may cause cholestasis.<ref name="pmid28145671">{{cite journal |vauthors=Fargo MV, Grogan SP, Saguil A |title=Evaluation of Jaundice in Adults |journal=Am Fam Physician |volume=95 |issue=3 |pages=164–168 |year=2017 |pmid=28145671 |doi= |url=}}</ref><ref name="pmid9287990">{{cite journal |vauthors=Leevy CB, Koneru B, Klein KM |title=Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease |journal=Gastroenterology |volume=113 |issue=3 |pages=966–72 |year=1997 |pmid=9287990 |doi= |url=}}</ref><ref name="pmid18609700">{{cite journal |vauthors=Hov JR, Boberg KM, Karlsen TH |title=Autoantibodies in primary sclerosing cholangitis |journal=World J. Gastroenterol. |volume=14 |issue=24 |pages=3781–91 |year=2008 |pmid=18609700 |pmc=2721433 |doi= |url=}}</ref><ref name="pmid3115390">{{cite journal |vauthors=Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ |title=Gall stones in sickle cell disease in the United Kingdom |journal=Br Med J (Clin Res Ed) |volume=295 |issue=6592 |pages=234–6 |year=1987 |pmid=3115390 |pmc=1247079 |doi= |url=}}</ref><ref name="pmid29226106">{{cite journal |vauthors=Malakouti M, Kataria A, Ali SK, Schenker S |title=Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do? |journal=J Clin Transl Hepatol |volume=5 |issue=4 |pages=394–403 |year=2017 |pmid=29226106 |pmc=5719197 |doi=10.14218/JCTH.2017.00027 |url=}}</ref>
Primary biliary cirrhosis must be differentiated from other disease that may cause [[cholestasis]].<ref name="pmid28145671">{{cite journal |vauthors=Fargo MV, Grogan SP, Saguil A |title=Evaluation of Jaundice in Adults |journal=Am Fam Physician |volume=95 |issue=3 |pages=164–168 |year=2017 |pmid=28145671 |doi= |url=}}</ref><ref name="pmid9287990">{{cite journal |vauthors=Leevy CB, Koneru B, Klein KM |title=Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease |journal=Gastroenterology |volume=113 |issue=3 |pages=966–72 |year=1997 |pmid=9287990 |doi= |url=}}</ref><ref name="pmid18609700">{{cite journal |vauthors=Hov JR, Boberg KM, Karlsen TH |title=Autoantibodies in primary sclerosing cholangitis |journal=World J. Gastroenterol. |volume=14 |issue=24 |pages=3781–91 |year=2008 |pmid=18609700 |pmc=2721433 |doi= |url=}}</ref><ref name="pmid3115390">{{cite journal |vauthors=Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ |title=Gall stones in sickle cell disease in the United Kingdom |journal=Br Med J (Clin Res Ed) |volume=295 |issue=6592 |pages=234–6 |year=1987 |pmid=3115390 |pmc=1247079 |doi= |url=}}</ref><ref name="pmid29226106">{{cite journal |vauthors=Malakouti M, Kataria A, Ali SK, Schenker S |title=Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do? |journal=J Clin Transl Hepatol |volume=5 |issue=4 |pages=394–403 |year=2017 |pmid=29226106 |pmc=5719197 |doi=10.14218/JCTH.2017.00027 |url=}}</ref>


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{| class="wikitable" align="center"
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Liver biopsy
Liver biopsy
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic cancer|Pancreatic carcinoma]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Pre-ampullary cancers
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ultrasound or [[Endoscopic retrograde cholangiopancreatography|ERCP]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ultrasound or [[Endoscopic retrograde cholangiopancreatography|ERCP]]  
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intrahepatic cholestasis of pregnancy
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Intrahepatic cholestasis of pregnancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
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[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Disease]]
[[Category:Rheumatology]]
[[Category:Medicine]]
[[Category:Up-To-Date]]

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: Mehrian Jafarizade, M.D [2], Anmol Pitliya, M.B.B.S. M.D.[3]

Overview

Primary biliary cirrhosis must be differentiated from other disease that may cause cholestasis including autoimmune hepatitis, common bile duct stone, hepatitis A (choelstatic type), EBV or CMV hepatitis, primary sclerosing cholangitis, pre-ampullary cancers, AIDS cholangiopathy, parasites induced cholestasis, and intrahepatic cholestasis of pregnancy.

Differentiating primary biliary cirrhosis from other Diseases

Primary biliary cirrhosis must be differentiated from other disease that may cause cholestasis.[1][2][3][4][5]

Disease History and clinical manifestations Diagnosis
Lab Findings Other blood tests Other diagnostic
Family history Fever RUQ Pain Pruritis AST ALT ALP BLR Indirect BLR Direct Viral serology
Primary biliary cirrhosis -/+ - -/+ + N/↑ N/↑ ↑ N ↑ - AMA positive Liver biopsy
Autoimmune hepatitis -/+ - - -/+ ↑ ↑ N ↑/N N - Anti-LKM antibody Liver biopsy
Common bile duct stone -/+ - + + N N ↑ N ↑ - Dilated ducts on ultrasound CT/ERCP
Hepatitis A (cholestatic type) - -/+ + + N/↑ N/↑ ↑ N ↑ + HAV- Ab Abdominal ultrasound
EBV / CMV hepatitis - -/+ + + N N ↑ N ↑ + Positive serology -
Primary sclerosing cholangitis -/+ - -/+ + N/↑ N/↑ ↑ N ↑ - ↑Autoantibodies (P-ANCA), hypergammaglobulinemia MRCP,

Liver biopsy

Pre-ampullary cancers + - -/+ -/+ N/↑ N/↑ ↑ N ↑ - - CT scan for diagnosis
AIDS cholangiopathy - - -/+ -/+ N/↑ N/↑ ↑ N ↑ - HIV Ab Ultrasound or ERCP
Parasites induces cholestasis - - -/+ -/+ N/↑ N/↑ ↑ N ↑ - Serology Ultrasound or ERCP
Intrahepatic cholestasis of pregnancy -/+ - -/+ + ↑ ↑ ↑ N ↑ - Thrombocytopenia Diagnosed clinically

References

  1. ↑ Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.
  2. ↑ Leevy CB, Koneru B, Klein KM (1997). "Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease". Gastroenterology. 113 (3): 966–72. PMID 9287990.
  3. ↑ Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.
  4. ↑ Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.
  5. ↑ Malakouti M, Kataria A, Ali SK, Schenker S (2017). "Elevated Liver Enzymes in Asymptomatic Patients - What Should I Do?". J Clin Transl Hepatol. 5 (4): 394–403. doi:10.14218/JCTH.2017.00027. PMC 5719197. PMID 29226106.

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