Term Paper on Cholesterol and Lipids


Term Paper on Cholesterol and Lipids

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Sample Term Paper on Cholesterol

Abnormal liver tests consist of mild-to-moderate elevations of ALT and AST but marked elevation of serum alkaline phosphatase levels, reflecting interference with bile drainage. This pattern is also seen in other forms of obstruction to bile flow, and these must be ruled out when PBC is considered. Cholesterol and lipids cannot be secreted normally for the same reason and accumulate in the blood. Serum gammaglobulin levels are variably elevated. In PBC, it is the IgM type that are characteristically (but not invariably) increased. In this disease, the IgM globulins never become IgG type, as is true in infectious diseases. Serum bilirubin is not elevated until late in the disease.

Liver biopsy is often necessary to differentiate this disease from several others that can be accompanied by similar liver test abnormalities. The destruction of small bile ducts can be recognized under the microscope, as can other findings associated with this disease. Fibrosis is present in variable amounts. Cirrhosis may be present when PBC is first discovered.

Unfortunately, treatment of PBC is not satisfactory. Corticosteroids and azathioprine have been prospectively evaluated and found to have little effect. The former worsens the bone disease known to be present and thus is not used. Another drug that suppresses the immune system, methotrexate, has been used in an experimental setting with only moderate and largely unsatisfactory effectiveness. At the present time, it appears that only the synthetic bile acid ursodeoxycholic acid (Actigall or Ursodiol) delays progression of this disease. It is given as tablets in divided doses for a total dose of 900 to 1000 mg. per day. Vitamin D and calcium supplements are advisable, because, in this disease and for unclear reasons, the metabolism of ingested vitamin D by the diseased liver is deficient. It has been observed that the resulting bone disease seen in PBC can be prevented by ingestion of this vitamin.

Prognosis of PBC varies. Some patients never develop cirrhosis, while in others it progresses relatively rapidly. Liver tests are closely monitored. When the serum bilirubin becomes elevated and is consistently above a level of 3 mg/dL, evaluation for liver transplantation is recommended. Primary sclerosing cholangitis (PSC) is considered to be another form of autoimmune hepatitis of the liver, although the underlying mechanism has not been definitively identified. It is characterized by inflammation in multiple scattered areas of larger bile ducts, in contrast to PBC, in which the smallest ducts are attacked.

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