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.
What are the complications of primary sclerosing cholangitis?
Cirrhosis
As primary sclerosing cholangitis progresses, the disease causes cirrhosis of the liver (irreversible
scarring of the liver) and liver failure; leading to the consideration of liver
transplantation. Primary sclerosing cholangitis is, in fact, one of the more common reasons for
liver
transplantation. Patients with advanced cirrhosis may develop
frequent infections, fluid in the ankles and the abdomen (ascites), internal bleeding from rupture of esophageal varices, and
mental confusion with
progression to coma (hepatic encephalopathy).
Cholangitis
The narrowing of the bile ducts predisposes the bile to bacterial infection
(cholangitis). Cholangitis is a serious and potentially life-threatening
infection with fever, shaking chills (rigors), jaundice, and upper abdominal
pain. Cholangitis can result in bacterial infection spreading to the blood
stream (a condition called sepsis). Sepsis can cause damage to kidneys and lungs
and even cause shock.
Cholangiocarcinoma
Cholangiocarcinoma (cancer of the bile ducts) is more common among patients
with primary sclerosing cholangitis. An estimated 9%-15% of patients with primary
sclerosing cholangitis will develop
cholangiocarcinoma, a very lethal type of cancer. Patients at highest risks for
developing cholangiocarcinoma are primary sclerosing cholangitis patients with cirrhosis who also have
long-standing ulcerative colitis.
Colon cancer
Long-standing chronic ulcerative colitis alone is a risk factor for
colon
cancer. Patients with both primary sclerosing cholangitis and ulcerative colitis have an even higher risk
for developing colon cancer than patients with ulcerative colitis alone.
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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