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home - Liver - Vascular Problems - Ischaemic Cholangiopathy Written by Dr Sebastian Zeki
Knowledge


Understands the risk of variceal bleeding as a complication of with
portal hypertension


Knows risk of variceal haemorrhage in cirrhotics who have not bled

Knows risk of bleeding related to variceal size endoscopic findings
and severity of liver dysfunction


Knows range of therapeutic options (both endoscopic and
pharmacological).

Skills
Recognises and can treat portal hypertension.
Behaviours
Manages patients with oesophageal varices with skill and
compassion

Able to convey the serious risks to patients and their relatives.

Also...

Knowledge


Recognises and shows understanding of vascular liver disease
including Budd-Chiari syndrome veno-occlusive disease and
portomesenteric venous thrombosis; understands the underlying
anatomy and physiology of these often complex conditions

Aware of need for investigation for associated myeloproliferative and
procoagulant conditions

Understands the role of anticoagulation and indications for further
intervention including TIPS surgery or transplantation

Skills
Can make careful clinical of these conditions and has
heightened awareness of liver vascular disease in differential
diagnosis

Able to make a potentially difficult diagnosis of less common variants
of vascular conditions

Behaviours
Shows ability to keep patient and relatives informed and to refer
appropriately for specialist management

Ischaemic Cholangiopathy

Ischaemic cholangiopathyThe hepatic artery (via the peribilary plexus) provides the exclusive blood supply to the major bile ducts. Causes:Liver transplantation (the most common cause) esp with non-heart beating donor graft.Vascular injury during biliary tract surgery.Arterial infusion of the chemotherapeutic agent floxuridine for palliation of liver metastases from gastrointestinal adenocarcinomas.Chemoembolization and radiation therapy.Hypercoagulable states leading to occlusion of the peribiliary plexus.In critically ill patients with respiratory failure. Cholestasis DiagnosisCholangiography can look like PSC, can get large perihilar bile ducts stricturing only, or a bile duct leak.Patients found to have a biliary stricture following liver transplan-tation should undergo a Doppler ultrasound of the hepatic vessels.In questionable cases, arteriography should be performed to rule out hepatic artery thrombosis. Management strategies:Stricture stenting and/ or dilatation.Patients may need re-transplantation. PathologyA liver biopsy is not useful.Histology includes ischaemic bile duct necrosis, casts and fibrosis and cholangitis without necrosis. Written by Dr Sebastian Zeki

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