Primary sclerosing cholangitis secondary prevention: Difference between revisions
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==Secondary Prevention== | ==Secondary Prevention== | ||
Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include:<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="pmid27330336">{{cite journal |vauthors=Kumar A, Wheatley D, Puttanna A |title=Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management |journal=Clin Med Insights Gastroenterol |volume=9 |issue= |pages=25–9 |year=2016 |pmid=27330336 |pmc=4902039 |doi=10.4137/CGast.S38451 |url=}}</ref> | Secondary prevention in patients with primary sclerosing cholangitis is aimed at screening for complications and coexisting conditions in these patients. These include:<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="pmid27330336">{{cite journal |vauthors=Kumar A, Wheatley D, Puttanna A |title=Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management |journal=Clin Med Insights Gastroenterol |volume=9 |issue= |pages=25–9 |year=2016 |pmid=27330336 |pmc=4902039 |doi=10.4137/CGast.S38451 |url=}}</ref> | ||
<small> | |||
{| class="wikitable" | {| class="wikitable" | ||
!align="center" style="background: #4479BA; color: #FFFFFF; " |Complications/ Coexisting Conditions | !align="center" style="background: #4479BA; color: #FFFFFF; " |Complications/ Coexisting Conditions | ||
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!align="center" style="background: #4479BA; color: #FFFFFF; " |Management | !align="center" style="background: #4479BA; color: #FFFFFF; " |Management | ||
|- | |- | ||
|[[Liver Cirrhosis]] | |style="background:#DCDCDC;" |[[Liver Cirrhosis]] | ||
| | | | ||
* [[Esophageal varices]], [[gastric varices]] | * [[Esophageal varices]], [[gastric varices]] | ||
| Line 25: | Line 26: | ||
* [[HCC]]: [[HCC]] is treated with [[ablation]], [[resection]] or [[liver transplantation]]. | * [[HCC]]: [[HCC]] is treated with [[ablation]], [[resection]] or [[liver transplantation]]. | ||
|- | |- | ||
|[[Gallbladder]] disease | |style="background:#DCDCDC;" |[[Gallbladder]] disease | ||
|[[Polyps]]/ masses | |[[Polyps]]/ masses | ||
|[[Abdominal]] [[ultrasound]] | |[[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]]. | |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]] | |style="background:#DCDCDC;" |[[IBD]] and associated risk of [[colon cancer]] | ||
|[[Colon cancer]] | |[[Colon cancer]] | ||
|[[Colonoscopy]] annually | |[[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]]. | |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 | |style="background:#DCDCDC;" |Metabolic bone disease | ||
|[[Osteopenia]]/ [[osteoporosis]] | |[[Osteopenia]]/ [[osteoporosis]] | ||
|[[DEXA scan]]. Repeat every 2-3 years. | |[[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]]. | |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]]. | ||
|} | |} | ||
</small> | |||
==References== | ==References== | ||
Revision as of 15:27, 20 November 2017
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Primary sclerosing cholangitis Microchapters |
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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
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:[1][2][3]
| Complications/ Coexisting Conditions | Presentation | Screening | Management |
|---|---|---|---|
| Liver Cirrhosis |
|
||
| 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
- ↑ 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.
- ↑ Kumar A, Wheatley D, Puttanna A (2016). "Primary Sclerosing Cholangitis: Therapeutic Options and Surveillance Management". Clin Med Insights Gastroenterol. 9: 25–9. doi:10.4137/CGast.S38451. PMC 4902039. PMID 27330336.