Hypercholesterolaemia in primary/secondary biliary cirrhosis

[Phloston]

What's the mechanism for hypercholesterolaemia in PBC/SBC?

UWorld is only as specific as: "hypercholesterolaemia secondary to obstruction."

I'm aware that there is the implication, based on that statement, that the buildup in the blood is merely because cholesterol is found in bile and the bile can't be excreted as easily, but I'm inquiring as to if there's a bit deeper of a mechanism.

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[Leon22]

What's the mechanism for hypercholesterolaemia in PBC/SBC?

UWorld is only as specific as: "hypercholesterolaemia secondary to obstruction."

I'm aware that there is the implication, based on that statement, that the buildup in the blood is merely because cholesterol is found in bile and the bile can't be excreted as easily, but I'm inquiring as to if there's a bit deeper of a mechanism.

i think it is the complication of cirhosis
cause defective metabolism of cholesterol(destroyed LDL receptor?)
and of course stasis of bile

 

[Phloston]

i think it is the complication of cirhosis
cause defective metabolism of cholesterol(destroyed LDL receptor?)
and of course stasis of bile

Sounds so simple when someone else says it. That's a good thought.

 

[OveractiveBrain]

What's the mechanism for hypercholesterolaemia in PBC/SBC?

UWorld is only as specific as: "hypercholesterolaemia secondary to obstruction."

I'm aware that there is the implication, based on that statement, that the buildup in the blood is merely because cholesterol is found in bile and the bile can't be excreted as easily, but I'm inquiring as to if there's a bit deeper of a mechanism.

Aiyah!

Ok. What is the ONLY way that cholesterol leaves the body? There is only ONE way. its through the bile.

Whether you have Primary Biliary Cirrhosis or Primary Sclerosing cholangitis the inflammation leads to biliary obstruction. The difference being PBC is microscopic and intrahepatic; PSC is macroscopic and both intra and extrahepatic. But it blocks up the biliary system. Period.

So... if the only way out of the body for cholesterol is through the biliary system. And now your biliary system is blocked... How does cholesterol get out of the body? Well, it doesn't.

it can get in as chylomicrons anywhere in the gut, anywhere there are lymphatics. YAY! More in. But it can't get out, because its only route is blocked. Nom Nom Nom. Eat cholesterol in. None out. Nom nom nom. Eat cholesterol in. None out. What happens to the balance of cholesterol? It goes up!

The question is ******ed, of course, because in clinical practice the thing that actually matters is the pruritis from bile salts and jaundice from bilirubin, not an elevated LDL on routine health maintenance. Besides, you're so worried about the liver transplant the dude with PSC has that you give give a shit about his LDL...

 

[ijn]

Aiyah!

Ok. What is the ONLY way that cholesterol leaves the body? There is only ONE way. its through the bile.

You lose a decent amount of cholesterol through the skin. About 70-100 mg a day.

 

[Big Baller]

This is first thought that came to my mind:
In PBC and SBC, most of the time liver is damaged and the function of liver is compromised which affects the production of albumin. When you have low levels of albumin, the transport of cholesterol is affected throughout the body which results in increased levels of cholesterol.

 

[Phloston]

You lose a decent amount of cholesterol through the skin. About 70-100 mg a day.

I knew someone was going to bring up vitamin D / steroid hormones. I think Overactivebrain was implying only clinically significant route of excretion.

70-100 mg seems like a lot though. Where do you source that from?

 

[ijn]

I knew someone was going to bring up vitamin D / steroid hormones. I think Overactivebrain was implying only clinically significant route of excretion.

70-100 mg seems like a lot though. Where do you source that from?

http://www.jlr.org/content/15/6/563.full.pdf

 

[Phloston]

http://www.jlr.org/content/15/6/563.full.pdf

Thanks for posting that.