GASTROENTEROLOGY ARTICLE OF THE WEEK
April 26, 2007
Abdalian R, Heathcote J. Sclerosing cholangitis: A focus on secondary causes. Hepatology 2006;44:1063-1074
1. Known causes of secondary SC include
a. surgical trauma
b. systemic chemotherapy with 5-FU
c. severe trauma with prolonged ICU care
d. Systemic mastocytosis
e. Ascaris infestation of the bile ducts
f. autoimmune pancreatitis
True or False
2. Eosinophilic cholangitis invariably presents with peripheral eosinophilia
3. Patients who recover from a severe episode of sepsis requiring prolonged intensive care may develop SSC
4. Predominant involvement of the CBD or hepatic ducts as opposed to diffuse involvement of the intra and extra-hepatic ducts favors SSC rather than PSC
5. Post-traumatic SC may be seen in patients who suffered extensive trauma, even if no hepatic trauma occurred.
6. While large peri-portal varices can compress the common or hepatic bile ducts, jaundice rarely ever develop in these cases in the absence of a stricture.
7. SSC related to autoimmune pancreatitis may improve or resolve with corticosteroid therapy
8. Targeted therapy against cryptosporidium or mycobacteria usually results in improvement of cholestasis in cases of HIV-associated SSC.
9. Portal vein thrombosis with cavernous transformation may lead to biliary strictures perhaps via an ischemic mechanism
10. Recurrent pyogenic cholangitis is often initiated by parasitic infestation of the bile ducts