ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-Based Learning (Day Two)

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This document is a summary of case studies in liver disease. Case study 1 describes a 54-year-old woman with elevated liver tests, fatigue, and mild pruritus. Further tests and imaging revealed primary biliary cholangitis, which is characterized by elevated liver tests, positive anti-mitochondrial antibodies, and a cholestatic profile. The patient was started on ursodeoxycholic acid (UDCA) as the primary treatment. Prognosis tools such as the UK-PBC Risk Calculator and Mayo Risk Score can help assess the severity of the disease.<br /><br />Case study 2 involves a 24-year-old man with elevated liver tests, fatigue, pruritus, and dark urine. Primary sclerosing cholangitis (PSC) was diagnosed based on elevated liver enzymes, positive p-ANCA, and compatible cholangiogram. PSC is associated with inflammatory bowel disease and has a variable natural history. There is no FDA-approved therapy for PSC, and treatment options include UDCA and vancomycin. Surveillance for hepatocellular carcinoma is recommended if advanced fibrosis or cirrhosis is present.<br /><br />Overlap syndromes, which occur in 10% of cases, involve combinations of autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis. It is important to differentiate between these three main categories of autoimmune liver disease and to manage each condition accordingly. Proactive monitoring for disease progression and complications like fluid retention, gastrointestinal bleeding, and hepatic encephalopathy is crucial.<br /><br />In summary, these case studies highlight the importance of accurate diagnosis and management of autoimmune liver diseases such as primary biliary cholangitis, autoimmune hepatitis, and primary sclerosing cholangitis. It is essential to tailor treatment to the specific disease and individual patient characteristics, while also monitoring for disease progression and potential complications.

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Andrea Gossard, APRN, CNP

Keywords

liver disease

case studies

primary biliary cholangitis

elevated liver tests

fatigue

pruritus

prognosis tools

UK-PBC Risk Calculator

Mayo Risk Score

primary sclerosing cholangitis