Liver Diseases Explained Clearly by | Cholestatic Disease

okay so welcome to another MedCram
lecture we’re continuing our discussion about actual diseases in terms of
cholestatic liver diseases so let’s go ahead to the table okay so here are
three major diseases we’ve got primary biliary cirrhosis
we’ve got primary skill Rowson cholangitis and we’ve got large bile
duct obstruction let’s talk about primary biliary cirrhosis first in this
area we’ve got these these categories alkaline phosphatase total bilirubin
history and diagnosis so primary biliary cirrhosis is more common in women it
causes fatigue and itching so think about a woman who’s itching and has some
jaundiced or the alpha is going to be definitely elevated and that’s because
what this primary biliary cirrhosis is what they are is like little portal
granulomas so little granulomas affecting the portal area and you get
destruction of the intrahepatic biliary ducts so this is intra hepatic
destruction of the biliary ducts we see this in middle-aged women and you do get
an increase in cholesterol retention it can be asymptomatic for years or even
decades so what you see is a high alkaline phosphatase you may actually
also see a high cholesterol as we mentioned and the the bilirubin does go
up but it doesn’t go up until later in the disease here’s the key though for
the diagnosis okay and this is what they’re going to test you on is you’re
going to have positive auntie my toe con drill antibodies that’s the key
positive anti mitochondrial antibodies in more than
95% of the time you can diagnose this with liver biopsy okay so if you’ve got
lady who fits into this category make sure you get an anti mitochondrial
antibody okay let’s talk about primary sclerosing cholangitis
now with this whereas this was just intro hepatic now we’re talking about
both intra and extra hepatic ductal problems it’s associated with actually
ulcerative colitis okay so you think about those type of inflammatory
diseases what you’re seeing here is fibrosis cholangitis of the biliary
ducts and what you’ll see is kind of like a beads on a string type of
appearance if you were to do a colon jia gram so you’ll have this fibrosis here’s
the biliary duct and then you’ll have this fibrosis fibrosis eyebro –ss so it
looks like beads on a string if you were to do a colon Geograph okay so this
beaded appearance makes you think of sclerosing cholangitis and so the
diagnosis is actually a k– Cola NGO clan geography if you will that means
you just shoot dye in there and you can see it light up it’s pretty pretty
interesting to see that so the beaded appearance is almost pathognomonic and
it’s associated with these diseases and it looks very similar to primary biliary
cirrhosis in terms of labs so you get the elevated alq foss and you get this
total bilirubin elevation okay what about large bile duct obstruction again
because alpha is an inducible enzyme you’ll see that you also see increased T
Billy here however because you actually have a large bile duct obstruction this
is going to look like gallbladder disease or cholecystitis you’re gonna
get pain you’re gonna get fever okay these type of things and the
diagnosis here again is you can do colon geography you could also do ultrasound
and you could do ercp that’s endoscopic retrograde cholangiopancreatography which is a long word so ii RCP you can
do an mr c p that’s where you use a magnetic resonance imaging you can do
ultrasound you can do clan geography okay so that takes care of the
cholestatic liver diseases and thanks for joining us you

39 thoughts on “Liver Diseases Explained Clearly by | Cholestatic Disease

  1. The A-a gradient, acid/base, and renal failure lectures were a godsend for a future doctor who has trouble with math and physiology. Haven't seen the liver lecs yet, I'm sure they are great.

    I wanted to request some lectures on cardiac physiology and that's why I'm commenting here. Really appreciate your work! Any place where I can donate or help MEDCRAM continue its mission?

  2. For large bile duct obstruction, what is the first best step for diagnosis? Ultrasound, for cheapness and non-invasiveness? (The Step 2 exam often asks us the question "what is the best next step in management?" which doesn't necessarily mean the gold standard of diagnosis).

  3. Just a minor comment, the "beads" on the "string" appearance of PSA is the normal bile duct while the fibrosis is the constriction point, you had explained it as the opposite. Great videos thanks a million.

  4. Love your lectures! I am a Critical Care Nurse.  I have recommended your videos to other RN's I work with.  You really make everything so simple to understand. 

  5. Excellent series, thank you very much. I find your level of detail great to cement critical details (pre-clinical MD student in Canada) and to convince me to slog through the endless litany of longer lectures.

    I also used a number of your cardiac, pulmonary and renal videos for review in my first year. No specific requests right now, but if you think it's important I imagine many of us will find it useful. 

  6. Thank you for uploading these videos. I'm currently an intern in Australia  and they're really good for a quick revision of topics especially when I need a quick recap for conditions that I see on the go. Please post videos on Neuro topics (specifically related to cerebrovascular accidents). Thanks again!

  7. Thanks very much for the Liver series!..Really enjoyed the use of tables!..Looking forward to more lectures!!

  8. Just found your videos and they are a lot of help and great review! They are explained clearly and with nice concrete examples. REQUEST: Noticed you are "Critical care" certified…so could you possibly, please, do a series on body reactions/pathophysiology in relation to Burn Victims?

  9. thank you for posting this video !!! I was diagnosed with Primary Sclerosing Cholongitis in 2009 and like to get as much information about this decease as I can !!!

  10. Very impressive videos. You make me want to become a doctor myself.

    I just received my bloodworm back and I am trying to educate myself before my appt. Im curious, can someone tell me if I'm dying here or what because I sure do feel awful and am going to see about hormone replacement therepy but i see the numbers and I am wondering now if i feel awful because of these blood levels. Also, I am type 2 diabetic and my numbers came back fasting blood glucose =126 Any help or information is appreciated thanks!

    LDH= 134
    IRON =113

  11. Reviewing for the step, 3 weeks away. A lot of YouTube videos on medical topics can be a waste of time or poorly done, but not these videos. Have watched about 8 of these videos, and will continue watching them when my brain needs a quick break from UWorld. Very high yield, and very well explained. Highly recommend for any medical student, this is a great use of your very limited time.

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