Primary biliary cirrhosis diagnostic study of choice: Difference between revisions
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{{Family tree | | | | | | | | | A01 | | | | | | | | A01=Abnormal ALP}} | {{Family tree | | | | | | | | | A01 | | | | | | | | A01=Abnormal [[ALP]]}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | | }} | {{Family tree | | | | | | | | | |!| | | | | | | | | }} | ||
{{Family tree | | | | | | | | | B01 | | | | | | | | B01=Confirm if the ALP is of liver origin}} | {{Family tree | | | | | | | | | B01 | | | | | | | | B01=Confirm if the [[ALP]] is of [[liver]] origin}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | | }} | {{Family tree | | | | | | | | | |!| | | | | | | | | }} | ||
{{Family tree | | | | | | | | | C01 | | | | | | | | C01=Abnormal GGT and/or total bilirubin and/or total cholesterol}} | {{Family tree | | | | | | | | | C01 | | | | | | | | C01=Abnormal [[GGT]] and/or total [[bilirubin]] and/or total [[cholesterol]]}} | ||
{{Family tree | | | | | | | | | |!| | | | | | | | | }} | {{Family tree | | | | | | | | | |!| | | | | | | | | }} | ||
{{Family tree | | | | | | | | | D01 | | | | | | | | D01=Drug history}} | {{Family tree | | | | | | | | | D01 | | | | | | | | D01=Drug history}} | ||
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{{Family tree | | | | E01 | | | | | | | | E02 | | | E01=Yes | E02=No}} | {{Family tree | | | | E01 | | | | | | | | E02 | | | E01=Yes | E02=No}} | ||
{{Family tree | | | | |!| | | | | | | | | |!| | | | }} | {{Family tree | | | | |!| | | | | | | | | |!| | | | }} | ||
{{Family tree | | | | F01 | | | | | | | | F02 | | | F01=Discontiue drug and observe | F02=Ultrasound}} | {{Family tree | | | | F01 | | | | | | | | F02 | | | F01=Discontiue drug and observe | F02=[[Ultrasound]]}} | ||
{{Family tree | | | | | | | | | | | | | | |!| | | | }} | {{Family tree | | | | | | | | | | | | | | |!| | | | }} | ||
{{Family tree | | | | | | |,|-|-|-|-|v|-|-|^|-|.| | | | }} | {{Family tree | | | | | | |,|-|-|-|-|v|-|-|^|-|.| | | | }} | ||
{{Family tree | | | | | | G01 | | | G02 | | | G03 | G01=Normal bile | {{Family tree | | | | | | G01 | | | G02 | | | G03 | G01=Normal [[bile duct]]s| G02=Dilated [[bile duct]](s)| G03=Pattern suggestive of infiltration}} | ||
{{Family tree | | | |,|-|-|^|.| | | |!| | | | |!| | }} | {{Family tree | | | |,|-|-|^|.| | | |!| | | | |!| | }} | ||
{{Family tree | | | H01 | | H02 | | H03 | | | H04 | H01=AMA postitve| H02=AMA negative| H03=Focal lesions| H04=Biopsy<sup>*</sup>}} | {{Family tree | | | H01 | | H02 | | H03 | | | H04 | H01=[[AMA]] postitve| H02=[[AMA]] negative| H03=Focal lesions| H04=[[Biopsy]]<sup>*</sup>}} | ||
{{Family tree | | | |!| | | |!| |,|-|^|-|.| | | | |}} | {{Family tree | | | |!| | | |!| |,|-|^|-|.| | | | |}} | ||
{{Family tree | | | I01 | | |!| I02 | | I03 | | | | I01=Probable PBC| I02=No| I03=Yes}} | {{Family tree | | | I01 | | |!| I02 | | I03 | | | | I01=Probable [[PBC]]| I02=No| I03=Yes}} | ||
{{Family tree | | | |!| | | |!| |!| | | |!| | | | |}} | {{Family tree | | | |!| | | |!| |!| | | |!| | | | |}} | ||
{{Family tree | | | J01 | | |!| |!| | | J02 | | | |J01=Confirmation of disease and histological stage| J02=CT and/or MRI}} | {{Family tree | | | J01 | | |!| |!| | | J02 | | | |J01=Confirmation of disease and histological stage| J02=[[CT]] and/or [[MRI]]}} | ||
{{Family tree | | | |!| | | |!| |!| |,|-|^|-|.| | | }} | {{Family tree | | | |!| | | |!| |!| |,|-|^|-|.| | | }} | ||
{{Family tree | | | K01 | | |!| |!| K02 | | K03 | K01=Biopsy| K02=IHBD stone| K03=Liver neoplasm | {{Family tree | | | K01 | | |!| |!| K02 | | K03 | K01=[[Biopsy]]| K02=IHBD stone| K03=[[Liver neoplasm]]}} | ||
{{Family tree | | | |!| | | |`|.|!|,|'| | | |!| }} | {{Family tree | | | |!| | | |`|.|!|,|'| | | |!| }} | ||
{{Family tree | |,|-|^|-|.| | |!|!|!| | | | |!| |}} | {{Family tree | |,|-|^|-|.| | |!|!|!| | | | |!| |}} | ||
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{{Family tree | | | | | | | M01 | | M02 | | | M01=Normal| M02=Strictures}} | {{Family tree | | | | | | | M01 | | M02 | | | M01=Normal| M02=Strictures}} | ||
{{Family tree | | | | | | | |!| | | |!| | | | }} | {{Family tree | | | | | | | |!| | | |!| | | | }} | ||
{{Family tree | | | | | | | N01 | | N02 | | | N01=Biopsy| N02=PSC<br>SSC}} | {{Family tree | | | | | | | N01 | | N02 | | | N01=[[Biopsy]]| N02=[[PSC]]<br>SSC}} | ||
{{Family tree | | | |,|-|-|-|+|-|-|-|.| | | | | }} | {{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 | | | 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}} | {{Family tree/end}} | ||
Revision as of 18:40, 5 February 2018
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Primary Biliary Cirrhosis Microchapters |
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Differentiating Primary Biliary Cirrhosis from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
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].
OR
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:
- An alkaline phosphatase 1.5 times the upper limit of normal
- Anti mitochondrial antibodies with titre 1:40 or higher
- Histology of liver demonstrating primary biliary cirrhosis
Diagnostic Algorithm
| 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
- ↑ 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.