ABSTRACT
Liver function tests are elevated in a variety of settings and with a mild elevation, it is difficult to decipher the cause. Typical causes of elevated liver enzymes may range from hepatocellular injury such as hepatitis C, to obstructive causes, such as primary sclerosing cholangitis. Primary sclerosing cholangitis is known to be associated with inflammatory bowel disease and may be more common than once thought.This article presents case study of a patient who presented with mildly elevated liver function tests and intermittent diarrhea. The patient was diagnosed with Crohn's disease and primary sclerosing cholangitis. The patient's presentation and the relation of inflammatory bowel disease and primary sclerosing cholangitis will be discussed. The importance of early detection of primary sclerosing cholangitis in an effort to decrease the morbidity and mortality from cholangiocarcinoma will also be emphasized. An overview of various diagnostic testing needed to make the diagnosis, as well as treatment modalities of both Crohn's disease and primary sclerosing cholangitis will also be presented.
Subject(s)
Carcinoma, Hepatocellular/prevention & control , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/drug therapy , Crohn Disease/diagnosis , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Blood Chemical Analysis , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis, Sclerosing/nursing , Colonoscopy/methods , Diagnosis, Differential , Drug Therapy, Combination , Follow-Up Studies , Humans , Immunosuppressive Agents/therapeutic use , Liver Function Tests , Male , Middle Aged , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Antiparkinson Agents/therapeutic use , Parkinson Disease/drug therapy , Antiparkinson Agents/economics , Clinical Trials as Topic , Dopamine Agonists/economics , Dopamine Agonists/therapeutic use , Humans , Levodopa/economics , Levodopa/therapeutic use , Selegiline/economics , Selegiline/therapeutic useABSTRACT
We have investigated the effects of the glucocorticoid, dexamethasone, and five structural analogs on Drosophila development in an effort to identify steroid ligands that may play a role in the embryogenesis of this organism. Embryos were exposed to glucocorticoids either by direct culture in supplemented medium, or by examining embryos from adult flies raised on supplemented fly food. After exposure, embryos were examined for developmental defects. At a morphological level, exposure to dexamethasone disrupts the dorsolateral folding of the amnioserosa during germ band extension. In addition, germ band retraction and dorsal closure is also disrupted. The phenocritical period of these effects is within the first 4 h of embryogenesis. This response is dosage sensitive, with embryos responding to concentrations of dexamethasone ranging from 10-6 to 10-3M. Furthermore, glucocorticoids which are closely related structural analogs of dexamethasone also disrupt germ band retraction and dorsal closure, while other tested steroids had no effect on embryonic development. At a molecular level, expression of the gene, Krüppel, is absent from the amnioserosa of dexamethasone-treated embryos. The cuticular phenocopy resulting from exposure to dexamethasone and related glucocorticoids is morphologically similar to the mutant phenotype associated with four genes required for germ band retraction, namely hindsight, serpent, tail-up and u-shaped. The results of this study represent the first association of a glucocorticoid with dose, stage and tissue specific effects on Drosophila development at both morphological and molecular levels.
