This article is about claims manipulation and the influence of context on the careers and outcomes of disputes. We explore eleven cases in which civil tort action was used when citizen opponents petitioned the government (lawsuits called SLAPPs or “strategic lawsuits against public participation”). Rather than being totally contingent on interactional and situational factors, these disputes followed two general trajectories of transformation, depending on whether they arose from an “internal” or “external” setting. Disputes initially tied to a broad cultural or political claims base were transformed into more narrow and concrete claims. Yet the original political claims of the lawsuit targets were less likely derailed.

The most common causes of chronic cholestatic liver disease are primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Both disease processes are characterized by a destruction of intrahepatic and/or extrahepatic biliary ducts. The etiology is not entirely clear; however, there is an underlying autoimmune component contributing to both disease processes. Although PBC and PSC are often diagnosed and managed in the outpatient setting, in some instances, a patient may have jaundice, fatigue, and pruritus requiring evaluation and determination of the cholestatic cause. Patients with PSC should be monitored for evidence of cholangiocarcinoma, colon cancer, and gallbladder polyps as they are at an increased risk of malignant neoplasms. Liver transplant has the potential for improving quality of life, although disease recurrence is a risk.