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home - IBD - Extra Intestinal Manifestations - Hepatobiliary Written by Dr Sebastian Zeki


Hepatobiliary manifestations of inflammatory bowel disease Primary Sclerosing CholangitisDiagnosis is on MRCP: Shows irregular bile ducts, with zones of both narrowing and dilatation.It increases the risk of both cholangiocarcinoma and colorectal carcinoma.Treatment involves rsodeoxycholic acid (ursodiol), which improves abnormal LFT’s/prognosis and reduce CRC risk.Tacrolimus will help LFT’s but not histology.ERCP may be used to treat dominant strictures by dilatation and/or stenting.Post live transplant recurrence occurs in 20%. CholelithiasisThis occurs in 20% of patients with ileitis or ileal resection.This is due to bile salt malabsorption- with depletion of bile salts and the formation of lithogenic bile. Granulomatous Hepatitis This is benignCauses include Crohn’s itself and sulfasalazine.Treatment involves steroids and other immunosuppressants Pancreatitis.This can occur for a number of diffe-ent reasons. PericholangitisThis is a subset of PSC-.Consider it in those with normal large ducts with cholestasis and UCLiver biopsy shows periportal and periductular fibrosis with a benign mixed cellular infiltration of the portal tracts.) SteatosisOccurs in up to 50% of IBD liver biopsies.This has a multifactorial cause- malnutri-tion and corticosteroids are the most important.It is usually related to disease severity and can be reversed with IBD treatment. Hepatic amyloidosisThis is secondary (reactive or AA) amy-loidosis in 1% Crohn’s and 0.1% UC.Risks include being male with colonic involvement.Treatment involves treating inflamm-tion or using colchicine. Liver abscess The cause may be a direct extension of intraabdominal abscesses/ portal pyemia with secondary seeding. Drug Induced HepatotoxicityUsually occurs within 3 weeks of starting meds.Sulfasalazine (hypersensitivity)- can cause both hepatocellular and cholestatic enzyme abnormalities.Azathioprine can cause an ALT rise(in 5%), cholestasis, veno-occlusive disease, and peliosis hepatis.Mercaptopurine can also cause hepatocellular and cholestatic hepatitis.A metabolite of azathioprine, 6-thioguanine (6-TG) causes elevated LFT’s in 26% of patients on 6-TG. Nodular regenerative hyperplasia was found in 76%.Methotrexate is associated with macrovesicular steatosis, hepatic fibrosis, and cirrhosis in a cumulative dose response fashion (worse with ETOH).Infliximab- can cause ALT rise and cholestasis rarely. Primary Boiliary Cirrhosis (PBC) This can occur with UC. Written by Dr Sebastian Zeki

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