Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

Primary Biliary Cirrhosis Primary Hyperparathyroidism 1211

rifampin 150 mg BID-TID, as second-line therapy

naltrexone 50 mg daily, for resistant cases

liver transplantation for uncontrollable pruritus

➣sicca syndrome: xerophthalmia: artificial tears without preser-

vatives

➣xerostomia: regular dental checkup for caries; oral moisturizers

➣osteoporosis: bone mineral density with dual X-ray absorptiom-

etry when the diagnosis of PBC is first established and yearly

thereafter; regular and adequate exercise

calcium 1,500 grams daily

vitamin D 1,000 iu daily

hormonal replacement therapy for perimenopausal women

cyclical etidronate 400 mg daily (for documented osteoporosis)

liver transplantation for severe osteoporosis

follow-up

During Treatment

■monitor biochemistry, including alkaline phosphatase and bilirubin

every 3–6 months

■regularly assess potential complications of PBC, including osteo-

porosis, pruritus, portal hypertension, and other extrahepatic dis-

eases

complications and prognosis

■serum bilirubin and Mayo risk score are both important indices that

predict survival

■liver transplantation is cure, although recurrence post-OLT does

occur

■post-OLT 1-year survival >90% and 5-year survival >60%

PRIMARY HYPERPARATHYROIDISM

DOLORES SHOBACK, MD

history & physical

History

■Most common in women over age 60

■Symptomatic or asymptomatic presentation

■Renal stones (10–15%)