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home - Biliary - Miscellaneous - Oriental cholangiohepatitis Written by Dr Sebastian Zeki

Oriental cholangiohepatitis

Other changes include ManagementAcute management is as per cholangi- Aetiological theories:Parasitic infection- implicated due to geo-graphic clustering eg Clonorchis sinensis, Opisthorchis species, and Fasciola hepatica.Bacterial infection-OCH patients may lack inhibitor of bacterial glucuronidases (which produces unconjugated bilirubin which when bound to calcium causes calcium bilirubinate stones to form).Stasis- Stricture formation may be the primary problem- reason for this is unknown. Long Term- 2 options:1. Remove stones and survey (usually need many sessions)- may need combi-nation therapy (stenting/ choledochos-copy etc)- 90% success/ 30% recur/ Role of UDCA unknown2. Biliary-enteric anastomosis- hepato-biliary resection can be done in localised disease- usually need biliary enteric anastomosis (eg hepaticojejunostomy) as well Clinical ManifestationsUsually present with Charcot's triad or complications thereof. Oriental Cholangiohepatitis = Intrahepatic pigment stones (calcium bilirubinate) with recurrent cholangitis, dilatation, and strictur-ing of the biliary tree.Disease of South East AsiansM=F40s=50sLower socioeconomic groups PathogenesisBile stasis causes recurrent cholangitis + stone formation proximal to biliary strictures. -Liver atrophy from multiple episodes of infection and inflamm-tion, leaving segments containing fibrous tissue and dilated ducts. -Enlargement and scarring of the liver with multiple capsular adhesions or deep subcapsular abscesses. -Hypertrophy of the papilla of the sphincter of Oddi as result of repeated passage of stones Written by Dr Sebastian Zeki Features of Diagnostic Cholangiography:Intra/ extra- hepatic duct dilatation+ focal IHD stricturing.Straightened fibrotic intrahepatic ducts with less acute or right-angled branching patterns.Left duct affected >R and earlier.Decreased branching /and acute tapering peripheral ducts.This produces a classic "arrowhead" sign.Always check stools for ova and parasites.