Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
The cause of primary sclerosing cholangitis is not known. A small subset (approximately 10%) of
primary sclerosing cholangitis
patients has a rapidly progressive form of the disease with early onset of
abdominal pain, fever, and itching that responds dramatically to treatment with
corticosteroids. Since corticosteroids (such as prednisone) are medications for
treating immune diseases such as ulcerative colitis, Crohn's disease, and
systemic lupus erythematosus, this small subset of primary sclerosing
cholangitis patients are believed to
have an immune disorder causing their primary sclerosing cholangitis.
What are the symptoms of primary sclerosing cholangitis?
Most patients with early primary sclerosing cholangitis have no symptoms, and the presence of
primary sclerosing cholangitis is
recognized only because of abnormally elevated blood levels of liver enzymes
(particularly alkaline phosphatase levels) that often are performed along with a
routine physical examination.
Early symptoms of primary sclerosing cholangitis include fatigue and bodily
itching (pruritus). As the
disease progresses, patients may develop
jaundice (yellowing of skin and
darkening of urine). Jaundice is due to the accumulation of bilirubin in the
body. The bilirubin accumulates because it is not able to be eliminated in the
bile due to prolonged obstruction of the bile ducts. The accumulation of
bilirubin turns the skin and whites of the eye (sclera) yellow. The reason for
the pruritus is not entirely known. It may be due to accumulation of bile salts
in the body, also as a result of obstruction of the bile ducts.
As primary sclerosing cholangitis progresses, patients typically develop right upper abdominal pain,
fever, fatigue, pruritus, and jaundice. These patients also are at risk of
developing primary sclerosing cholangitis complications.
The patients with the autoimmune form of primary sclerosing cholangitis have more rapid and early onset
of symptoms of abdominal pain, jaundice and fever than the majority of patients
with the more indolent form of primary sclerosing cholangitis.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Liver cancer is the fifth most common cancer in the world and the majority of patients with liver cancer will die within one year as a result. Patients with associated cirrhosis caused by chronic hepatitis B or C infections, alcohol, and hemochromatosis are at the greatest risk of developing liver cancer. Many patients with liver cancer do not develop symptoms until the advanced stages of the tumor which usually makes prognosis poor. The combination of an imaging study (ultrasound, CT, or MRI scans) and an elevated blood level of alpha-fetoprotein will most effectively diagnose liver cancer, while a liver biopsy can make a definitive diagnosis. Medical treatments, including chemotherapy, chemoembolization, ablation, and proton beam therapy, are not very effective. Surgical removal of the tumor or a liver transplant may be most effective in certain cases.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Colon cancer is a malignancy that arises from the inner lining of the colon. Most, if not all, of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
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