Guest guest Posted December 3, 2007 Report Share Posted December 3, 2007 How do I know when I need to see my doctor? I always have the terrible fatigue, but I have spells of a low grade fever, chills, nausea, Upper Right Quadrant pain in the liver area, body aches, decreased mental sharpness and night sweats. These symptoms are the reason I went to the doctor earlier this year and what lead to PSC diagnosis with an ECRP and a liver biopsy. When I talked to the doctor at my last appointment, I was pretty well told well it is only going to get worse and I just will have to deal with it. No one has said anything about taking an antibiotic! Any suggestions? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2007 Report Share Posted December 3, 2007 Dear ; The treatment of cholangitis REQUIRES antibiotics, and if your doctor was reading the literature he/she should know this. Please share this abstract with him: Curr Treat Options Gastroenterol. 2007 Mar;10(2):111-9. Treatment of primary sclerosing cholangitis. Rost D, Kulaksiz H, Stiehl A Adolf Stiehl, MD Department of Medicine, University of Heidelberg, Medizinische Universitätsklinik, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. adolf_stiehl@.... Aims of treatment for primary sclerosing cholangitis are as follows: prevention of progression of hepatobiliary disease, reduction of symptoms and consequences of cholestasis (pruritus, osteoporosis), and prevention of complications (colorectal cancer, hepatobiliary cancer). Ursodeoxycholic acid (UDCA) improves biliary secretion and laboratory parameters of cholestasis, but its effects on liver histology and survival are not clear. It reduces the incidence of dysplasias and carcinomas of the colon in patients with colitis and possibly has a beneficial effect on the incidence of bile duct carcinomas. At present, UDCA represents the most promising therapeutic option. Immunosuppressive treatment has not been proven to be effective; it appears to be indicated in the overlap syndrome with autoimmune hepatitis but may be harmful in bacterial cholangitis. Bacterial cholangitis is common in patients with dominant stenoses and requires antibiotic treatment. Endoscopic treatment of dominant stenoses improves cholestasis and prolongs survival in comparison to predicted survival. Pruritus represents a problem in some patients, and cholestyramine represents the first-line treatment. If ineffective, opioid antagonists, rifampin, or ondansetron may be tried. For treatment of osteoporosis and osteopenia, calcium and vitamin D supplementation are recommended, and in selected cases, bisphosphonates may be indicated. In patients with severe cholestasis and coagulation defects, parenteral supplementation of vitamin K may be indicated. During treatment, all patients should be regularly screened for colonic and bile duct carcinomas. Patients with cirrhosis of the liver and its complications are treated accordingly, and in end-stage disease, liver transplantation is indicated. PMID: 17391626. Dawne; I am posting this at the risk of violating copyright law. As I understand it the Pubmed database is open access, and the abstracts are not subject to copyright. I am posting the abstract because when I post the actual URL for the article, it is too long for this message board to handle properly, and the link does not display properly: http://www.ncbi.nlm.nih.gov/sites/entrez? Db=pubmed & Cmd=ShowDetailView & TermToSearch=17391626 & ordinalpos=2 & itool=En trezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Dave R. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2007 Report Share Posted December 3, 2007 Thanks, but I am really fustrated because I talked to my hepatologist at Baylor and my local hepatologist and neither mentioned antibiotics so where do I turn now? I think I will call my transplant cordinator in the morning and try to get some advice. \- -- In , " " wrote: > > Dear ; > > The treatment of cholangitis REQUIRES antibiotics, and if your doctor > was reading the literature he/she should know this. Please share this > abstract with him: > > Curr Treat Options Gastroenterol. 2007 Mar;10(2):111-9. > > Treatment of primary sclerosing cholangitis. > > Rost D, Kulaksiz H, Stiehl A > > Adolf Stiehl, MD Department of Medicine, University of Heidelberg, > Medizinische Universitätsklinik, Im Neuenheimer Feld 410, 69120 > Heidelberg, Germany. adolf_stiehl@... > > Aims of treatment for primary sclerosing cholangitis are as follows: > prevention of progression of hepatobiliary disease, reduction of > symptoms and consequences of cholestasis (pruritus, osteoporosis), and > prevention of complications (colorectal cancer, hepatobiliary cancer). > Ursodeoxycholic acid (UDCA) improves biliary secretion and laboratory > parameters of cholestasis, but its effects on liver histology and > survival are not clear. It reduces the incidence of dysplasias and > carcinomas of the colon in patients with colitis and possibly has a > beneficial effect on the incidence of bile duct carcinomas. At present, > UDCA represents the most promising therapeutic option. > Immunosuppressive treatment has not been proven to be effective; it > appears to be indicated in the overlap syndrome with autoimmune > hepatitis but may be harmful in bacterial cholangitis. Bacterial > cholangitis is common in patients with dominant stenoses and requires > antibiotic treatment. Endoscopic treatment of dominant stenoses > improves cholestasis and prolongs survival in comparison to predicted > survival. Pruritus represents a problem in some patients, and > cholestyramine represents the first-line treatment. If ineffective, > opioid antagonists, rifampin, or ondansetron may be tried. For > treatment of osteoporosis and osteopenia, calcium and vitamin D > supplementation are recommended, and in selected cases, bisphosphonates > may be indicated. In patients with severe cholestasis and coagulation > defects, parenteral supplementation of vitamin K may be indicated. > During treatment, all patients should be regularly screened for colonic > and bile duct carcinomas. Patients with cirrhosis of the liver and its > complications are treated accordingly, and in end-stage disease, liver > transplantation is indicated. PMID: 17391626. > > Dawne; I am posting this at the risk of violating copyright law. As I > understand it the Pubmed database is open access, and the abstracts are > not subject to copyright. I am posting the abstract because when I post > the actual URL for the article, it is too long for this message board > to handle properly, and the link does not display properly: > > http://www.ncbi.nlm.nih.gov/sites/entrez? > Db=pubmed & Cmd=ShowDetailView & TermToSearch=17391626 & ordinalpos=2 & itool= En > trezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum > > Dave R. > Quote Link to comment Share on other sites More sharing options...
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