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home - Biliary - Miscellaneous - AIDS Cholangiopathy Written by Dr Sebastian Zeki

AIDS Cholangiopathy

Types Written by Dr Sebastian Zeki Involvement of large intrahepatic ducts is usually associated with C.parvum and CMV infection. Long extrahepatic bile duct stricture with or without intrahepatic scleros-ing cholangitis is unusual. Papillary stenosis alone-10 % Combined intrahepatic and extrahe-patic sclerosing cholangitis without papillary stenosis-20 % or less- not found in PSC Combined papillary stenosis and sclerosing cholangitis 50 to 60 % AIDS Cholangiopathy Treatment-Medical treatment against causative organisms doesnt help.Sphincterotomy for papillary stenosis- gives relief but ALP may remain increased.Bile duct stricture stenting can be used but is not useful for sclerosing cholangitis alone.Sclerosing cholangitis may benefit from UDCA 300 mg tds. Diagnosis test:-Inc Serum GammaGT in 90 %.-Inc alkaline phosp to >700 in 75 %.-Mild inc in serum ALT and AST is common.-Inc bilirubin, if present, < twice the upper limit of normal.-Normal LFT's in 20%.ERCP or MRCP are diagnostic. Sclerosing cholangitisMild abdominal pain Papillary Stenosis-Assoc with severe abdominal pain Clincal ManifestationsPatients usually have a CD4 count < 100/mm3.RUQ and epigastric pain and diarrhea is present.Fever and jaundice is less common. Causes:Cryptosporidium parvum- most common.Microsporidium.CMV.Cyclospora cayetanensis.