Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

An update on the management of cholestatic liver diseases

Gautham Appanna and Yiannis Kallis
Download PDF
DOI: https://doi.org/10.7861/clinmed.2020-0697
Clin Med September 2020
Gautham Appanna
ABarts Health NHS Trust, London, UK
Roles: specialist registrar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: gautham.appanna@nhs.net
Yiannis Kallis
BBarts Health NHS Trust, London, UK
Roles: consultant hepatologist and honorary senior lecturer
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Article Figures & Data

Tables

    • View popup
    Box 1.

    Autoimmune conditions associated with primary biliary cholangitis

    Sjogren’s syndrome
    Autoimmune thyroid disease, eg Hashimoto’s
    Rheumatoid arthritis
    Coeliac disease
    Systemic sclerosis
    Pernicious anaemia
    Vitiligo
    Addison’s disease
    • View popup
    Table 1.

    Options for the medical management of cholestatic pruritis

    PharmacotherapyDoseNotes
    Cholestyramine4 g/day to a maximum of 16 g/day as requiredAdministration requires adequate spacing to avoid affecting the absorption of other medications
    Rifampicin300–600 mg/dayNeeds careful monitoring of LFTs; small risk of hepatotoxicity
    Naltrexone50 mg/dayCareful dosing required to avoid opioid withdrawal side effects
    Sertraline100 mg/day
    Gabapentin300 mg/day, dose titrate as normal
    • LFTs = liver function tests.

    • View popup
    Box 2.

    Ways in which a patient with primary sclerosing cholangitis may present to the general physician

    Incidental findings of abnormal liver biochemistry in an asymptomatic individual
    Persistent abnormal liver biochemistry in patients followed up for inflammatory bowel disease
    Jaundice or pruritis secondary to cholestasis
    Bacterial cholangitis
    Jaundice secondary to liver decompensation
    Complications of portal hypertension (variceal bleeding or ascites)
    Cholangiocarcinoma or gallbladder carcinoma
    • View popup
    Box 3.

    Alternative causes of sclerosing cholangiopathy

    Chronic choledocholithiasis (bile duct stones)
    Chronic pancreatitis
    Immunoglobulin G4-related disease
    Traumatic bile duct injury (iatrogenic, penetrating/blunt trauma)
    Ischaemic bile duct injury
    HIV cholangiopathy
    Parasitic infections of the biliary tract
    Helminth (ascaris)
    Trematoda (flukes)
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
An update on the management of cholestatic liver diseases
Gautham Appanna, Yiannis Kallis
Clinical Medicine Sep 2020, 20 (5) 513-516; DOI: 10.7861/clinmed.2020-0697

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
An update on the management of cholestatic liver diseases
Gautham Appanna, Yiannis Kallis
Clinical Medicine Sep 2020, 20 (5) 513-516; DOI: 10.7861/clinmed.2020-0697
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • ABSTRACT
    • Key points
    • Primary biliary cholangitis
    • Primary sclerosing cholangitis
    • Conclusion
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Acute-on-chronic liver failure
  • Sarcopenia in cirrhosis: A practical overview
Show more CME: Hepatology

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians