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Hepatobiliary
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Written by Dr Sebastian Zeki
MCQs for this page
Hepatobiliary
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Hepatobiliary manifestations of inflammatory bowel
disease
Primary Sclerosing Cholangitis
Diagnosis
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%.
Cholelithiasis
This 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 benign
Causes
include
Crohn’s itself and
sulfasalazine.
Treatment
involves steroids and
other immunosuppressants
Pancreatitis
.
This can occur for a number of diffe
-
ent reasons.
Pericholangitis
This is a subset of PSC-.
Consider it in those with normal large ducts with cholestasis
and UC
Liver biopsy shows periportal and periductular fibrosis with
a benign mixed cellular infiltration of the portal tracts.)
Steatosis
Occurs 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 amyloidosis
This 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 Hepatotoxicity
Usually 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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