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Complications of Cholestasis

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Cholestatic Liver Disease

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

The complications of cholestasis significantly impact morbidity and quality of life in patients with chronic cholestatic liver disease. Undiagnosed and untreated, these complications can lead to clinical problems which could potentially overshadow the underlying primary liver disease. Most of what is known in this field is based on studies of patients with primary biliary cirrhosis (PBC) and, to a lesser degree, primary sclerosing cholangitis (PSC), which is then extrapolated to patients with other cholestatic diseases. Recent advances in the pathogenesis of some of these complications have improved our understanding of the underlying mechanisms but much work still needs to be done. This chapter reviews the pathophysiology and management of: osteoporosis, pruritus/itching, dyslipidemia, fat-soluble vitamin deficiencies, steatorrhea, and fatigue.

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Abbreviations

AlkPhos:

Alkaline phosphatase

ATX:

Autotaxin

BMD:

Bone mineral density

CLD:

Chronic liver disease

CRH:

Corticotropin releasing hormone

DEXA:

Dual-energy X-ray absorptiometry

IGF:

Insulin growth factor

LCAT:

Lecithin-cholesterol acyltransferase

LPA:

Lysophosphatidic acid

LP-X:

Lipoprotein X

LP-Y:

Lipoprotein Y

MARS:

Molecular adsorbent recirculating system

OLT:

Orthotopic liver transplant

OPG:

Osteoprotegerin

PBC:

Primary biliary cirrhosis

PROMIS-HQ:

Patient-reported outcome measure information system health-assessment questionnaire

PSC:

Primary sclerosing cholangitis

PTH:

Parathyroid hormone

PXR:

Pregnane X receptor

RANK:

Receptor activator of nuclear factor kappa-B

RANKL:

Receptor activator of nuclear factor kappa-B Ligand

RMP:

Rifampin

SIBO:

Small intestinal bowel overgrowth

UGT:

Uridine diphosphate glucuronosyltransferase

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Authors and Affiliations

  1. Division of Digestive & Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room K.5.140C, Dallas, TX, 75390-9151, USA

    Abrar Ahmed M.D. & Marlyn J. Mayo M.D.

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  1. Abrar Ahmed M.D.
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  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA

    Elizabeth J. Carey

  2. Mayo Clinic, Phoenix, Arizona, USA

    Keith D. Lindor

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Ahmed, A., Mayo, M.J. (2014). Complications of Cholestasis. In: Carey, E., Lindor, K. (eds) Cholestatic Liver Disease. Clinical Gastroenterology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1013-7_9

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