SAVED
File name .JPG
File alt. text
Image should be px wide x px tall.
Select Image
home - IBD - Extra Intestinal Manifestations - Hepatobiliary Written by Dr Sebastian Zeki

Hepatobiliary

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

Related Stories

•Enteropathic SAPHO Syndrome in Ulcerative Colitis Responsive to Bisphosphonates

•Immune Thrombocytopenic Purpura (ITP) With Ulcerative Colitis (UC)

•The malic acid inhibiting inflammation in ankylosing spondylitis by interfering M1 macrophage polarization

•Successful treatment of Crohn's disease-related peripheral spondyloarthritis with upadacitinib: two case reports and case-based review

•Insights into renal and urological complications of inflammatory bowel disease