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.
How is the diagnosis of primary sclerosing cholangitis made?
The diagnosis of primary sclerosing cholangitis is suspected from the symptoms (such as fatigue,
itching, and jaundice) and abnormal laboratory tests (such as abnormally
elevated blood levels of alkaline phosphatase and other liver enzymes); and is
confirmed by demonstration of abnormally thickened bile ducts using special
radiological tests. It is also important to exclude other diseases that can
mimic primary sclerosing cholangitis. These diseases include primary biliary cirrhosis (PBC), gallstones in
the bile ducts, bile duct cancers and strictures.
Blood tests
The blood level of alkaline phosphates is usually elevated in primary
sclerosing cholangitis. The blood
levels of other liver enzymes (AST and ALT) may also be mildly elevated. Except
in those patients with the autoimmune form of primary sclerosing cholangitis, the bilirubin usually is
normal but gradually increases as the disease progress.
Antimitochondrial
antibody (AMA), which is elevated in patients with PBC, is usually normal in
patients with primary sclerosing cholangitis.
Radiologic tests
Endoscopic retrograde cholangio-pancreatography
(ERCP) and magnetic
resonance cholangio-pancreatography (MRCP) are commonly performed to visualize
the intrahepatic and extrahepatic ducts. These ducts are typically normal in
appearance in patients with PBC, but in primary sclerosing cholangitis patients, these ducts have a beaded
appearance (multiple narrowings along the ducts with areas of widening in
between).
MRCP is noninvasive and safe. ERCP is more invasive and carries a 5%-6% chance
of causing an attack of acute pancreatitis. However, ERCP has the advantage of
obtaining cell samples (a process called brush cytology) from the bile ducts.
Brush cytology is not very accurate, but sometimes can help to diagnose
cholangiocarcinoma. Also, during ERCP, doctor can also insert balloons and
stents across major areas of narrowing (dominant strictures) to relieve
obstruction and treat infection.
Colonoscopy
Patients with primary sclerosing cholangitis have a high likelihood of also having ulcerative colitis,
and, as mentioned previously, patients with primary sclerosing cholangitis and ulcerative colitis have
higher risks of developing colon cancer. Thus,
colonoscopy is important to both
diagnose ulcerative colitis and for early detection of cancer or precancerous
conditions.
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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