{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 20, Ep 2 of 3: Primary Biliary Cholangitis","html":"","width":"100%","height":180,"duration":712,"description":"Episode two works primary biliary cholangitis, the anti-mitochondrial-antibody cholestatic disease of the middle-aged woman, as a biochemical-target-driven problem. The diagnosis is usually made on labs alone, treatment starts with ursodeoxycholic acid for everyone, and escalation is driven by where the alkaline phosphatase and bilirubin sit at twelve months, because those numbers are the surrogate for survival. The second-line landscape changed when obeticholic acid left the US market, leaving elafibranor and seladelpar as the two approved PPAR-targeted agents that tend to improve rather than worsen the itch. The close is the stepped, mechanism-targeted pruritus algorithm from cholestyramine through rifampin, sertraline, naltrexone, and the emerging ileal transporter inhibitors.\n \nTopics covered\n\nClinical picture and pathogenesis of primary biliary cholangitis\nLab-based diagnosis and when biopsy is needed\nFlorid duct lesion and staging\nBiphasic natural history and prognostic scores\nUrsodeoxycholic acid mechanism and twelve-month response\nSecond-line agents after obeticholic acid withdrawal\nFat-soluble vitamins, bone, and the lipid profile\nStepped mechanism-targeted pruritus algorithm\nIleal bile acid transporter inhibitors\n \n \nKey decisions\n\nDiagnose primary biliary cholangitis on labs alone when there is a positive anti-mitochondrial antibody, an alkaline phosphatase above one and a half times normal, and transaminases under five times normal with no alternative explanation; biopsy is unnecessary and reserved for antibody-negative disease or suspected overlap.\nStart every patient on ursodeoxycholic acid thirteen to fifteen milligrams per kilogram per day for life, and assess response at twelve months: the alkaline phosphatase should fall toward one and a half times normal with a normal bilirubin, and failure or intolerance triggers a second agent.\nUse the twelve-month continuous risk scores that combine age, bilirubin, alkaline phosphatase, albumin, and...","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}