[Cholestatic liver diseases].
Primary biliary cirrhosis (PBC), autoimmune cholangitis (AIC = AMA-negative PBC) and primary sclerosing cholangitis (PSC) are autoimmune cholestatic liver diseases. Overlap syndromes combine characteristics of cholestatic liver diseases and autoimmune hepatitis. In PBC, alkaline phosphatase and gamma-glutamyl transferase are elevated, to a lesser degree aminotransferases. Histology shows bile duct lesions. Anti-mitochondrial antibodies are typical. Ursodeoxycholic acid (UDC) is established therapy that slows or even stops the disease progression, at least in early stages of the disease. In non-responders immunosuppression is recommended. PSC is mostly associated with chronic inflammatory bowel diseases. P-ANCA are frequent. Bile duct lesions revealed by retrograde cholangiography are characteristic. UDC is given as therapy. Bile duct strictures or bacterial cholangitis may be late sequelae and should be treated by antibiotics or bile-duct dilatation. Cirrhosis may ultimately develop in PBC and PCS. In progressed PBC or PSC liver transplantation is indicated.
Medizinische Universitätsklinik Freiburg, Abteilung Innere Medizin II.
R
R
Thimme
O G
OG
Opitz
H E
HE
Blum
W
W
Kreisel
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000982:Antipruritics / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D001652:Bile Ducts / Q000473:pathology; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002758:Cholangiography; D002761:Cholangitis / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D002779:Cholestasis / Q000175:diagnosis / Q000628:therapy; D002792:Cholestyramine Resin / Q000627:therapeutic use; D004796:Clinical Enzyme Tests; D003937:Diagnosis, Differential; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008103:Liver Cirrhosis / Q000209:etiology; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis / Q000628:therapy; D016031:Liver Transplantation; D009270:Naloxone / Q000627:therapeutic use; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D017294:Ondansetron / Q000627:therapeutic use; D010956:Plasmapheresis; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D000924:Anticholesteremic Agents; D000982:Antipruritics; D002756:Cholagogues and Choleretics; D009292:Narcotic Antagonists; D002792:Cholestyramine Resin; D009270:Naloxone; D017294:Ondansetron; D009271:Naltrexone; D014580:Ursodeoxycholic Acid