Makindo Medical Notes"One small step for man, one large step for Makindo" |
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| Condition | How to recognise (features • labs • imaging/biopsy) | First-line & follow-up |
|---|---|---|
| 🩷 Autoimmune Hepatitis (AIH) | Hepatitic LFTs (ALT/AST ≫ ALP), fatigue/jaundice; can be acute severe. ↑ IgG; ANA/SMA (type 1), anti-LKM1 (type 2), anti-SLA/LP. Biopsy: interface hepatitis with plasma cells. | Prednisolone → taper + azathioprine (or MMF if AZA-intolerant). Aim normal ALT/AST & IgG; monitor q3–6 mo. Cirrhosis → HCC surveillance (US ± AFP 6-monthly). |
| 💚 Primary Biliary Cholangitis (PBC) | Cholestatic pattern (ALP ≫ ALT), pruritus/fatigue, xanthelasma. ↑ IgM; AMA-M2 (~95%); if AMA-neg: ANA gp210/sp100. Imaging to exclude obstruction; biopsy if atypical. | UDCA 13–15 mg/kg/day; check 12-mo biochemical response. Inadequate → consider obeticholic acid* or bezafibrate†. Manage pruritus (cholestyramine → rifampicin → naltrexone). DEXA & fat-soluble vitamins; HCC surveillance if cirrhotic. |
| 🌀 Primary Sclerosing Cholangitis (PSC) | Often men 30–40 yrs; strong UC link; cholestatic LFTs, pruritus/cholangitis. p-ANCA common (non-specific); check IgG4 to exclude IgG4-SC. MRCP: multifocal strictures “beading”; biopsy for small-duct disease. | No proven disease-modifying drug; treat complications, endoscopic therapy for dominant strictures; transplant if advanced/intractable pruritus. Cancer risks: cholangiocarcinoma, gallbladder Ca, colorectal Ca (if IBD) → colonoscopy 1–2-yearly; gallbladder US annually; local CCA surveillance protocols. |
| 🔗 Overlap (AIH–PBC / AIH–PSC) | Mixed cholestatic + hepatitic picture; combined serology (e.g., AMA with ↑IgG/ANA/SMA). Biopsy often needed to confirm. | Combine therapies: steroids ± AZA for AIH component + UDCA for cholestasis. Tailor surveillance to both conditions; specialist management. |
* Obeticholic acid is contraindicated in decompensated cirrhosis (Child-Pugh B/C). † Bezafibrate is off-label in the UK; consider in non-responders under specialist care.