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Abstract: The patient, a 59-year-old female, presented with hepatic discomfort, abdominal distension, and yellow urine. After a comprehensive examination, she was diagnosed with primary biliary cirrhosis (a type of autoimmune liver disease) and was in the decompensated phase. The patient was recommended to be hospitalized. After standard treatment of liver preservation, enzyme reduction and diuresis, the patient’s malaise and abdominal distension were reduced, his appetite was increased, and the indicators on review were significantly improved.
Basic information】Female, 59 years old
Disease Type】Primary biliary cirrhosis
Hospital】Liaoning Provincial People’s Hospital
Consultation time】March 2018
Treatment plan】Intravenous medication (polyenyl phosphatidylcholine injection, magnesium isoglycyrrhizate injection), oral medication (ursodeoxycholic acid tablets, silymarin capsules, levocarnitine oral solution, metoprolol tartrate tablets) + insulin subcutaneous injection
Treatment Period】Inpatient treatment for 8 days, followed by outpatient treatment in 2 weeks
Treatment effect】The patient’s fatigue and bloating were reduced, appetite was increased, and the indicators on the follow-up examination were significantly improved.
I. Initial consultation
The patient was admitted to the hospital with recurrent episodes of liver discomfort, abdominal distension, and yellow urine for 12 years, which had been aggravated for 1 week. He was diagnosed with primary biliary cirrhosis and was given oral treatment with ursodeoxycholic acid tablets, and was discharged from the hospital when his condition improved. After that, the patient went to several hospitals and was diagnosed with primary biliary cirrhosis and was treated with oral ursodeoxycholic acid tablets, and his condition was basically stable. 6 months ago, the patient developed abdominal distension and swelling of both lower extremities and was seen at the Hospital for Infectious Diseases, where ultrasound examination of the liver, gallbladder and spleen indicated ascites. The patient came to the hospital with chronic liver disease, mild yellow staining of skin and sclera, suspicious positive mobile turbid sounds, and no edema in both lower limbs. The liver function was abnormal, and the ultrasound indicated cirrhosis, splenomegaly, ascites, and portal vein widening. The patient and his family were informed of his condition, and the patient requested hospitalization and was admitted to the ward.
II. Treatment process
After admission, the examination was completed. The white blood cell count and platelet count decreased, and the test for hepatitis B and C was negative. Glutathione transaminase, glutamic oxalacetic transaminase, alkaline phosphatase and other indicators increased. Gastroscopy suggested esophageal varices (severe) and chronic superficial gastritis with erosion. Autoimmune liver disease spectrum: positive antinuclear antibodies, positive antimitochondrial antibodies, positive anti-Ro52 antibodies. Primary biliary cirrhosis with decompensated phase was determined on the basis of examination with type 2 diabetes, chronic superficial gastritis, hypoproteinemia, and hypokalemia. He was given hepatoprotective, enzyme-lowering, diuretic, and protein-replenishing treatment to remove ascites. After admission, he was given routine secondary care, bed rest, and a low-salt, low-fat diabetic diet. Intravenous polyenyl phosphatidylcholine injection and magnesium isoglycyrrhizate injection, oral ursodeoxycholic acid tablets and silymarin capsules, etc. Levocarnitine oral solution can improve lipid metabolism and assist in the treatment of hyperlipidemia and fatty liver, and metoprolol tartrate tablets were taken orally to lower blood pressure. For the problem of diabetes mellitus, insulin was given subcutaneously in the morning and evening by consultation with the endocrinology department, and blood glucose was monitored.
III. Treatment effect
After 5 days of treatment with improvement of cholestasis, liver protection, enzyme lowering, lipid lowering and blood glucose lowering, the patient showed remarkable effects, with reduced fatigue, bloating, increased appetite, and rechecked all abnormal indexes returning decreased lipids, decreased blood glucose, and significantly improved liver function test. Indicators such as ghrelin, ghrelin and alkaline phosphatase tended to be normal. The patient’s condition improved and was given discharge after 3 days of consolidation treatment. After discharge, the patient continued to take medication for liver protection, cholestasis, lipid lowering, blood pressure lowering and glucose lowering. The patient was instructed to follow up with the outpatient clinic in 2 weeks.
IV. Notes
We are glad that after active treatment the patient’s condition is improving and all abnormal indicators are regressing. Primary biliary cirrhosis is an autoimmune, chronic progressive cholestatic liver disease and therefore requires long-term medication and self-monitoring of blood glucose and adjustment of insulin dosage. If the elevated lipids are not severe and the liver function is abnormal, do not apply statin lipid-lowering drugs, which can easily cause liver damage. In the diet low salt and low fat diabetic diet, the patient was discharged from the hospital with low albumin level and normal renal function, high protein diet is recommended.
V. Personal insight
Primary biliary cirrhosis is a relatively common type of autoimmune liver disease, mainly manifested as intrahepatic cholestasis with elevated alkaline phosphatase and γ-glutamyl transpeptidase, which is mainly treated with ursodeoxycholic acid tablets. Patients often have more than 2 autoimmune diseases, such as dry syndrome, ulcerative colitis, systemic lupus erythematosus, etc. The prevalence is high in middle-aged and elderly women, with a male to female ratio of 1:9.