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Related Concept Videos

Chronic Pancreatitis I: Introduction01:24

Chronic Pancreatitis I: Introduction

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The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
Acute pancreatitis arises suddenly and lasts for a brief duration, while chronic pancreatitis is a long-term affliction...
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Chronic Bowel Disorders: Introduction01:17

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Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
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Acute Pancreatitis II: Clinical Manifestations and Management01:30

Acute Pancreatitis II: Clinical Manifestations and Management

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Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
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Chronic Pancreatitis II: Collaborative Care01:29

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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
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Acute Pancreatitis I: Introduction01:27

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Pancreatitis is inflammation of the pancreas, an organ located behind the stomach. It can be either acute or chronic.
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
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Diseases of the Liver and Gallbladder01:26

Diseases of the Liver and Gallbladder

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Liver and gallbladder diseases are a significant health concern, with prominent conditions including cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), and gallstones. Jaundice is a common manifestation of liver and biliary disease.
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
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Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
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[Primary biliary cholangitis].

Pierre-Antoine Soret1, Olivier Chazouillères1, Christophe Corpechot1

  • 1Service d'hépatologie, Centre de référence des maladies inflammatoires des voies biliaires et hépatites auto-immunes (MIVB-H), hôpital Saint-Antoine AP-HP, Paris, France - Centre de recherche Saint-Antoine (CRSA), Sorbonne Université et Inserm, Paris, France.

La Revue Du Praticien
|February 11, 2022
PubMed
Summary

Primary biliary cholangitis (PBC) is a chronic liver disease affecting bile ducts. While ursodeoxycholic acid improves outcomes, some patients require second-line treatments for better results.

Keywords:
CholangitisLiver Cirrhosis, Biliary

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Area of Science:

  • Hepatology
  • Autoimmune Diseases
  • Gastroenterology

Background:

  • Primary biliary cholangitis (PBC) is the most common chronic cholestatic liver disease.
  • It is an autoimmune condition causing inflammation and destruction of small bile ducts, potentially leading to fibrosis and cirrhosis.
  • PBC predominantly affects women over 40, often presenting with subtle or absent symptoms like pruritus and fatigue.

Purpose of the Study:

  • To outline the diagnostic criteria for PBC.
  • To discuss the standard of care treatment and its limitations.
  • To introduce second-line treatment options for patients with inadequate response to standard therapy.

Main Methods:

  • Diagnosis relies on cholestatic biochemical features (elevated ALP and GGT) and specific auto-antibodies, notably M2 anti-mitochondrial antibodies.
  • Ursodeoxycholic acid (UDCA) is the established first-line treatment.
  • Evaluation of patient response to UDCA and consideration of alternative therapies.

Main Results:

  • UDCA has significantly improved the prognosis for PBC patients.
  • A substantial proportion (30-40%) of patients exhibit an insufficient biochemical response to UDCA.
  • These non-responders remain at elevated risk for disease complications.

Conclusions:

  • While UDCA is effective, a significant subset of PBC patients requires further therapeutic intervention.
  • Second-line treatments, such as obeticholic acid or fibrates, should be considered alongside UDCA for non-responders.
  • Optimizing treatment strategies is crucial for managing PBC and preventing long-term complications.