Diagnosis Of Primary Biliary Cirrhosis Research Articles

The laparoscopic staging of primary biliary cirrhosis.

The laparoscopic photographs of 38 cases of primary biliary cirrhosis with high titres of mitochondrial antibodies were reviewed. The quality of laparoscopic photography is now so high that it proved possible to use these photographs as the basis of a system of laparoscopic staging. By analogy with the system of histological classification, the disease was divided into four stages. Laparoscopy provides an alternative approach to the diagnosis of primary biliary cirrhosis, which should be based on clinical, biochemical, immunological and morphological data. However, by laparoscopy alone it is improssible to separate pure primary biliary cirrhosis from its mixed forms with chronic active hepatitis.

The immunology of liver disease

Serum immunoglobulin (IgG, IgA, IgM) values are not diagnostic of any one liver disease, although a high serum IgM in patients with chronic cholestasis makes obstruction to large main bile ducts unlikely. Changes in circulating antibodies are nonspecific and include positive antinuclear factor in some patients with chronic hepatitis and primary biliary cirrhosis. The antimitochondrial (M) test has proved useful in the differential diagnosis of primary biliary cirrhosis from surgical obstruction to main bile ducts. The antibody against smooth muscle is positive in about two thirds of patients with activechronic hepatitis. Delayed type hypersensitivity reactions are impaired in primary biliary cirrhosis, but this effect seems to be a consequence of the disease rather than related to etiology. A form of chronic hepatitis and cirrhosis is associated with persistence of Australia antigen in the serum. In some of these patients primary hepatocellular carcinoma may develop. The evaluation of immunosuppressive regimens in the treatment of liver disease, particularly active chronic hepatitis and primary biliary cirrhosis, has been impeded by lack of controlled prospective trials. However, recent controlled trials have suggested that prednisolone increases the life span of patients with active chronic hepatitis. Serum alpha-feto-globulin can be found in about 30 per cent of Caucasians and 60 per cent of non-Caucasians suffering from primary hepatocellular carcinoma.

Mitochondrial antibody test--a clue to diagnosis of primary biliary cirrhosis: Report of Two Interesting Cases

Mitochondrial antibody test--a clue to diagnosis of primary biliary cirrhosis: Report of Two Interesting Cases

Serological and histological diagnosis of primary biliary cirrhosis.

A simple immunofluorescence test for antibody to a mitochondrial antigen present in many tissues is a reliable method of distinguishing most cases of primary biliary cirrhosis from jaundice due to extrahepatic biliary tract obstruction. Of 30 cases diagnosed as primary biliary cirrhosis, 26 had antimitochondrial antibody whereas none of 77 cases with jaundice due to extrahepatic bile duct obstruction showed this serological abnormality. The antibody was also found in the serum of three of 42 patients who had other forms of cirrhosis and in two of 266 patients with no evidence of liver disease.Clinical, biochemical, and serological findings favour the view that primary biliary cirrhosis is a real entity which, in our present state of knowledge, cannot be defined clearly by any single method of investigation. In particular, the liver may show a variety of histological appearances which, interpreted without regard to the other features of the case, may lead to errors in diagnosis.