Cholangitis chronic

Approximately 3-10% of patients with inflammatory bowel disease have some degree of liver abnormality. The spectrum of liver dysfnnction associated with inflammatory bowel disease ranges from fatty changes to pericholangitis, sclerosing cholangitis, chronic active hepatitis and cirrhosis. Ulcerative colitis is more commonly associated with liver abnormality than Crohn s disease. 

Long -term sequelae of chronic pancreatitis include dietary malabsorption, impaired glucose tolerance, cholangitis, and potential addiction to opioid analgesics. 

Chronic obstruction of the common bile duct by the inflamed pancreas can cause icterus, cholangitis, and biliary cirrhosis.36... 

Approximately 11% of patients with ulcerative colitis have hepatobiliary complications including fatty liver, pericholangitis, chronic active hepatitis, cirrhosis, sclerosing cholangitis, cholangiocarcinoma, and gallstones. 

Unlabeled Uses Prophylaxis of liver transplant rejection, treatment of alcoholic cirrhosis, biliary atresia, chronic hepatitis, gallstone formation, sclerosing cholangitis... 

Primary sclerosing cholangitis is characterised by inflammation, fibrosis and destruction of the intrahepatic and/or extrahepatic bile ducts. It results in a chronic cholestatic liver disease that may lead to liver cirrhosis. Cholangiocarcinoma occurs in approximately 10-30% of patients. PSC occurs more frequently in men between the ages of 20 and 40, with a male female ratio of 2 1. It is often associated with inflammatory bowel disease, particularly chronic ulcerative colitis. 

Cholangitis, endocarditis lenta, malaria, eosinophilic granuloma, tuberculosis, chronic hepatitis (27), etc. 

Pruritus is accompanied by scratch marks (s. pp 85, 232), which the tormented patient inflicts, often with great intensity, on all accessible parts of the body (f as long as it bleeds, it doesn t itch any more ). Fresh scratch marks on the skin alternating with older, blood-encrusted sites are characteristic of the body surface of a patient suffering from chronic cholestasis, such as primary biliary cholangitis, (s. fig. 13.3)... 

Complications The following complications have been reported (i.) cholangitis, (2.) obstructive jaundice, (i.) intrahepatic cholelithiasis, (4.) sepsis, (J.) portal hypertension (oesophageal varices, portal vein thrombosis, chronic Budd-Chiari syndrome, etc.), (6.) thrombosis of the inferior vena cava, (7.) amyloidosis, (8.) immune complex-associated glomerulonephritis, (9.) metastases, (10.) acute on chronic liver insufficiency or acute liver failure, and (11.) bronchobiliary fistula. 

A case report of blastomycosis of the hepatobiliary i yi -tem describes the following conditions (39) development of chronic cholangitis in the area of the left hepatic duct with encroachment of the mycotic inflammation to the left lobe of liver in cases of predisposing and/or preexisting choledocholithiasis histological evidence of liver granulomas and periportal fibrosis marked increase in alkaline phosphatase and y-GT. (40)... 

If it is not possible to remove the obstruction and achieve defect healing (i.e. with fibrous residues) of the chronic (relapsing) cholangitis, the inflammatory destruction of periportal liver parenchyma will result in portoportal bridge formations and thus isolation of hepatic lobules by means of connective tissue. Monolobular, mostly micronodular biliary cirrhosis develops. (4l, 54) (s. fig. 32.5)... 

Fig. 32.4 Chronic cholangitis. Periportal fibrosis dark red/brown-ish discolouration of the hver with greenish patches finely nodular surface (= scattered light reflection)...

Fig. 32.5 Biliary cirrhosis following chronic relapsing and abscess-forming cholangitis green and grey dirty colouration of the deformed micronodular surface. (Chronic cholecystitis with formation of a shrunken gall bladder)...

Immune cholangitis differs markedly from the early forms of PSC. In particular, the fibre coats surrounding proliferated ductuli, which are typical of PSC and which develop early, and the PAS-positive colouring of the basal membrane are absent. Biliary cirrhosis must be anticipated as the final stage. (454, 469, 471) (s. p. 644) Therapy is with UDCA, first of all as monotherapy. With non-responders, the additional administration of azathioprine plus prednisolone is recommended. In coexistent chronic IBD, the administration of mesala-zine (5 ASA) is indicated. Liver transplantation is required in the individual case. (455, 461, 463, 465)... 

Davis, J.J., Heyman, M.B., Ferrell, L., Kerner, J., Kerlan, R.jr., Thaler, M.M. Sclerosing cholangitis associated with chronic cryptosporidiosis in a child with a congenital immunodeficiency disorder. Amer. X Gastroenterol. 1987 2 1196-1202... 

Ludwig, J., Dickson, E.R., McDonald, G.S.A. Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis). Virchows Arch. (A) 1978 379 103-111... 

Rnbin, E., Schaffner, F., Popper, H. Primary biliary cirrhosis chronic non-suppurative destructive cholangitis. Amer. J. Pathol. 1965 46 387-407... 

Cangemi, J.R., Wiesner, R.H., Beaver, S.J., Ludwig, J., MacCarty, R.L., Dozois, R.R., Zinsmeister, A.R., LaRusso, NJ . Effect of proctocolectomy for chronic ulcerative colitis on the natural history of primary sclerosing cholangitis. Gastroenterology 1989 96 790-794... 

Hashimoto, E., Lindor, K.D., Homburger, HA., Dickson, E.R., Czaja, A.J., Wiesner, R.H., Ludwig, J. Immunohistochemical characterization of hepatic lymphocytes in primary biliary cirrhosis in comparison with primary sclerosing cholangitis and autoimmune chronic active hepatitis. Mayo Clin. Proc. 1993 68 1049-1055... 

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