Last minute questions for Dr. tommorrow

[Guest guest]

I want to know what kind of questions I should ask my GI Dr. in the

morning. I was supposed to have an ERCP and liver biopsy last week but

after just 1 week on Urso my liver enzymes came down some so they

canceled it, I had my blood drawn again 6 days later and my liver

enzymes shot way back up. I've been feeling crappy in the meantime. I'm

going in to see what the plan will be. I really think I need to have

an ERCP and I was wondering if anyone else has any ideas of questions I

should ask. I will be my first visit since my diagnosis.

Thanks,

[Guest guest]

Hi ;

I guess that the really difficult questions to ask, are ... what are

relative risks and benefits of having an ERCP and biopsy?... will the

results affect your treatment?

I looked back at your earlier post (Message #98156), and you mentioned

that your doctor had seen intrahepatic bile-duct dilation in a CT scan,

and that you have had UC for several years. This, together with

elevated LFTs and your other symptoms certainly does seem consistent

with PSC.

Ursodiol seems to have improved your serum liver enzyme levels, and so

it would be good to stay on this. This would probably be the same

conclusion whether you had the ERCP and biopsy or not.

What level of ursodiol are you taking, and did your liver enzyme levels

rise again while you were still taking ursodiol [or was this associated

with stopping ursodiol therapy after the first week?]. If the level of

ursodiol you are taking is low, perhaps you could ask to have that dose

increased to see whether this improves you bile flow and LFTs over a

longer time period? Many PSCers are taking 28-30 mg/kg per day of

ursodiol.

If the duct blockages are way up in the liver (intrahepatic), and not

readily accessible to manipulation by ERCP, then the ERCP might help in

diagnosis, but not in opening strictures. Would trying to reach these

intrahepatic strictures by ERCP do more harm than good, by potentially

introducing bacteria into the biliary tree? Is the purpose of the ERCP

just to confirm diagnosis or to try to do therapeutic intervention like

placing a stent, or doing balloon dilitation? Is a purpose of the ERCP

to take some bile duct brushings to look at the cells for signs of

abnormal cells?

If you are still itching, you might ask to try rifampin, which has been

very helpful in reducing itching symptoms for our son.

Best regards, and good luck with your doctor's visit tomorrow.

Dave R.

>

> I want to know what kind of questions I should ask my GI Dr. in the

> morning. I was supposed to have an ERCP and liver biopsy last week

but

> after just 1 week on Urso my liver enzymes came down some so they

> canceled it, I had my blood drawn again 6 days later and my liver

> enzymes shot way back up. I've been feeling crappy in the meantime.

I'm

> going in to see what the plan will be. I really think I need to have

> an ERCP and I was wondering if anyone else has any ideas of questions

I

> should ask. I will be my first visit since my diagnosis.

> Thanks,

>

>