Primary Biliary Cirrhosis and Sclerosing Cholangitis

[wishingformore]

Hey everyone..I have a question that hopefully someone can answer. In First Aid (2010) it states that Primary Sclerosing Cholangitis is associated with hyper IgM but in Rapid Review it states that Primary Biliary Cirrhosis is associated with high IgM. Can anyone shed some info?

Thanks.

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[username456789]

Hey everyone..I have a question that hopefully someone can answer. In First Aid (2010) it states that Primary Sclerosing Cholangitis is associated with hyper IgM but in Rapid Review it states that Primary Biliary Cirrhosis is associated with high IgM. Can anyone shed some info?

Thanks.

I actually posed this very same question yesterday on the First Aid Errata thread, but no one answered it as of yet. So hopefully this thread will garner some more attention.

For the record, I would tend to think RR is correct.

 

[kryptik]

Primary Biliary Cirrhosis from emedicine:

The exact mechanism of the liver damage is unknown, although evidence indicates that it can be of autoimmune origin. The data supporting this hypothesis are as follows: (1) abnormalities of the humoral and cellular immune systems (ie, elevated serum levels of immunoglobulins, mainly immunoglobulin M [IgM]), (2) multiple circulating autoantibodies, (3) granulomas in the liver and regional lymph nodes, (4) impaired regulation of both B and T lymphocytes, and (5) the association of this disease with a variety of autoimmune-mediated diseases (eg, autoimmune thyroiditis; keratoconjunctivitis sicca; scleroderma; calcinosis cutis, Raynaud phenomenon, esophageal motility disorder, sclerodactyly, and telangiectasia [CREST] syndrome).2

personally I always side with RR whenever there is a discrepancy between FA and RR

 

[512TA]

Hey everyone..I have a question that hopefully someone can answer. In First Aid (2010) it states that Primary Sclerosing Cholangitis is associated with hyper IgM but in Rapid Review it states that Primary Biliary Cirrhosis is associated with high IgM. Can anyone shed some info?

Thanks.

i am using FA 2008 and it has IgM for PBC

 

[HTxFrog]

I just came across this and I knew I had seen a post on here about it. I think they both have increased IgM. Krptik already posted that first thing about Primary Biliary Cirrhosis(http://emedicine.medscape.com/article/171117-diagnosis), which I also checked out myself, but I looked up Primary Sclerosis Cholangitis just to be sure, and it has increased IgM also http://emedicine.medscape.com/article/187724-diagnosis
Anyways I'm sure they won't have that as the main distinguisher on a question, but just so noone sees increased IgM and automatically thinks that its one or the other I figured I'd post this. Hopefully they just put anti-mitochondrial antibodies in the stem b/c I don't really know how else to tell them apart except microscopy I guess which I am not too fond of

 

[Salpingo]

I doubt that IgM will be the only qualifier for the question. For sclerosing, I'm putting all my money that male gender, ulcerative colitis, maybe onion-skin morphology will appear. For primary biliary, same bet is on female, antimitochondrial Ab, portal hypertension, and either no jaundice or late jaundice.

That's the one nice thing about this test: every question, they give you multiple opportunities to apply knowledge of obscure facts.

 

[username456789]

I doubt that IgM will be the only qualifier for the question. For sclerosing, I'm putting all my money that male gender, ulcerative colitis, maybe onion-skin morphology will appear. For primary biliary, same bet is on female, antimitochondrial Ab, portal hypertension, and either no jaundice or late jaundice.

That's the one nice thing about this test: every question, they give you multiple opportunities to apply knowledge of obscure facts.

Unless it's one of those "here's a clear presentation of a disease. Which of the following would likely be found on a workup?
A) High levels of serum IgM
B) ......"

Fortunately, it seems like there's apparently enough ambiguity that they wouldn't use the IgM as the splitter between PSC and PBC, but it's not uncommon for them to give a presentation, then list hallmark findings of several similar diseases.