{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 20, Ep 1 of 3: Sorting the Immune Liver Diseases and Autoimmune Hepatitis","html":"","width":"100%","height":180,"duration":673,"description":"Episode one of the Autoimmune and Cholestatic Liver Diseases chapter builds the sorting framework for the three immune liver diseases and then works autoimmune hepatitis in depth. The organizing idea: pattern plus demographics plus antibodies place a patient into autoimmune hepatitis, primary biliary cholangitis, or primary sclerosing cholangitis within the first two sentences of the vignette. Autoimmune hepatitis is then the ANA and smooth-muscle-antibody interface hepatitis of the middle-aged woman with elevated IgG, confirmed on biopsy. The second half is treatment: steroid induction plus a steroid-sparing agent, the type one versus type two split, the simplified score, and why withdrawal is cautious because relapse is the rule.\n \nTopics covered\n\nSorting framework: target cell sets the biochemical pattern\nDemographics and IBD association across the three diseases\nAntibody panel and IgG profile as the discriminator\nAutoimmune hepatitis pathogenesis and two clinical faces\nType one versus type two serologic subtypes\nSimplified scoring system and its blind spots\nInterface hepatitis and ancillary histology\nSteroid induction, azathioprine, and budesonide\nRemission endpoints and cautious withdrawal\n \n \nKey decisions\n\nSort the three immune liver diseases by pattern plus demographics plus antibodies: hepatocellular with ANA or smooth-muscle antibody and high IgG is autoimmune hepatitis, cholestatic with anti-mitochondrial antibody is primary biliary cholangitis, and cholestatic in a man with ulcerative colitis needing MRCP is primary sclerosing cholangitis.\nCheck a TPMT level before starting azathioprine, because TPMT-deficient patients metabolize it to toxic levels and develop severe myelosuppression; induce a non-cirrhotic adult with prednisone thirty to sixty milligrams daily plus azathioprine fifty to one hundred fifty milligrams daily.\nBudesonide at nine milligrams daily is an alternative induction agent for non-cirrhotic patients but must not be used in...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}