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

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This document summarizes two case studies in liver disease: one on primary biliary cholangitis (PBC) and the other on autoimmune hepatitis (AIH). In the first case study, a 54-year-old woman with elevated liver tests was diagnosed with PBC. She had symptoms of fatigue and mild pruritus, and her ultrasound and blood tests ruled out other causes of liver disease. The recommended treatment for PBC is ursodeoxycholic acid (UDCA) or obeticholic acid for those who cannot take UDCA.<br /><br />In the second case study, a 24-year-old man with elevated liver tests was diagnosed with AIH. He had symptoms of fatigue, pruritus, and dark urine. AIH is more common in females and can affect both children and adults. The diagnosis is based on elevated aminotransferases and positive autoantibodies. Treatment for AIH usually involves corticosteroids, with or without other medications, and prompt treatment significantly improves survival.<br /><br />The document also provides information on primary sclerosing cholangitis (PSC), which is more common in males and often associated with inflammatory bowel disease. There is no FDA-approved therapy for PSC, but ursodeoxycholic acid has been studied. Surveillance for cholangiocarcinoma is recommended, and screening for hepatocellular carcinoma may be advisable in cases of advanced fibrosis or cirrhosis.<br /><br />The document concludes with practice pearls, emphasizing the importance of understanding the distinct therapeutic management of each autoimmune liver disease and monitoring for progression and complications such as fluid retention, gastrointestinal bleeding, and hepatic encephalopathy.

Asset Subtitle

Andrea Gossard, APRN, CNP

Keywords

liver disease

primary biliary cholangitis

autoimmune hepatitis

PBC

AIH

ursodeoxycholic acid

obeticholic acid

corticosteroids

primary sclerosing cholangitis

PSC