Search

The characteristics of primary biliary cirrhosis, which is described as a slow and progressive autoimmune disease, are presented. The autoimmune responses associated with this disorder, and their treatments are discussed in detail.

Whenever a patient has elevated liver enzymes but no symptoms, the doctor should repeat the blood test to make sure it is correct. Elevated blood levels of liver enzymes is usually caused by liver damage. However, a minimal elevation is probably not important if the patient is known not to have liver disease. Elevated liver enzymes can be caused by alcohol, some drugs, chronic hepatitis, autoimmune hepatitis, hemochromatosis, Wilson's disease, hepatic steatosis, and alpha(sub 1)-antitrypsin deficiency. Celiac sprue, muscle disorders, and strenuous exercise can also cause elevated liver enzymes.

Primary biliary cirrhosis is a liver disease characterized by an autoimmune attack against cell mitochondria. This damages the small bile ducts in the liver. The disorder affects women primarily and is characterized by itching, fatigue, jaundice and an enlarged liver. A liver biopsy can confirm the diagnosis. Itching can be controlled with drugs that bind bile acids and ursodiol, colchicine and methotrexate are used to treat the underlying autoimmune disorder. The most effective treatment is a liver transplant.

Patients diagnosed with primary sclerosing cholangitis should be offered treatment even if they have no symptoms. Primary sclerosing cholangitis is characterized by a narrowing of the bile ducts within and outside the liver due to chronic inflammation. Its cause is not known, but chronic bacterial infections, toxins produced by intestinal bacteria or toxins produced during digestion have been suggested as causes. It appears to have an immune component, since immune system abnormalities are often present. Most patients are first detected following abnormal liver function tests. The diagnostic method of choice is an ERCP, which involves using a catheter to inject a dye into the bile ducts so they can be visualized on X-ray. The ducts will have a characteristic beaded appearance. No medical treatment is entirely effective, and advanced liver disease requires a liver transplant. Most studies report median survival rates of 9 to 12 years after diagnosis.

Gallstones are found in about 10% of all adults and are a major cause of illness and death. In patients of Western nations, they are composed primarily of cholesterol, along with bilirubin, calcium salts, and proteins. They form when the cholesterol concentration in bile is greater than the bile's capacity to keep it in solution. Cholesterol crystals form and over time become stones. They are more prevalent in women than in men and are associated with childbearing, estrogen therapy, use of oral contraceptives, obesity and rapid weight loss. Pain in the upper right quadrant of the abdomen is the most common complaint, although many patients with gallstones have no symptoms. Treatment is generally recommended only for symptomatic patients and patients with acute cholecystitis or bile-duct obstruction. Until the 1980s, open surgical cholecystectomy was the standard treatment, but since then laparoscopic techniques, which are less painful and costly, have become the preferred method of treatment.