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Pericholangitis Clinical Presentation

  • Author: Robert P Myers, MD, FRCPC; Chief Editor: BS Anand, MD  more...
 
Updated: Jun 22, 2016
 

History

Symptoms of patients with pericholangitis vary considerably, depending on the reported series. Frequently, the diagnosis is made in asymptomatic patients with inflammatory bowel disease (IBD) when routine liver biochemistry studies reveal a cholestatic liver profile.

Other patients present with cholestatic features, including jaundice and pruritus. Jaundice may develop insidiously or occur as abrupt intermittent episodes of icterus. Finally, some patients may present with typical features of acute cholangitis—namely, fever, jaundice, and abdominal pain.

In a minority of patients, pericholangitis progresses to severe fibrosis and cirrhosis. In these patients, features of hepatic decompensation (eg, the development of ascites, edema, bleeding related to portal hypertension, or hepatic encephalopathy) may predominate.

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Physical Examination

The physical examination findings in patients with pericholangitis are usually unremarkable. Abnormal physical findings include the following:

  • Jaundice
  • Hepatomegaly
  • Ascites and edema
  • Stigmata of chronic liver disease (spider angiomata), leukonychia, muscle wasting, gynecomastia and testicular atrophy (in men), and palmar erythema
  • Skin excoriations due to pruritus
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Contributor Information and Disclosures
Author

Robert P Myers, MD, FRCPC Assistant Professor, Director, Viral Hepatitis Clinic, Division of Gastroenterology, Department of Medicine, University of Calgary Faculty of Medicine, Canada

Robert P Myers, MD, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, Royal College of Physicians and Surgeons of Canada, Canadian Association of Gastroenterology

Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Radiologists, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References
  1. Bambha K, Kim WR, Talwalkar J. Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. Gastroenterology. 2003 Nov. 125(5):1364-9. [Medline].

  2. Mistilis SP. Pericholangitis and ulcerative colitis I. Pathology, etiology, and pathogenesis. Ann Intern Med. 1965. 63:1-16.

  3. Wee A, Ludwig J, Coffey RJ. Hepatobiliary carcinoma associated with primary sclerosing cholangitis and chronic ulcerative colitis. Hum Pathol. 1985 Jul. 16(7):719-26. [Medline].

  4. Nikolaidis NL, Giouleme OI, Tziomalos KA. Small-duct primary sclerosing cholangitis. A single-center seven-year experience. Dig Dis Sci. 2005 Feb. 50(2):324-6. [Medline].

  5. Heikius B, Niemela S, Lehtola J. Hepatobiliary and coexisting pancreatic duct abnormalities in patients with inflammatory bowel disease. Scand J Gastroenterol. 1997 Feb. 32(2):153-61. [Medline].

  6. Bayraktar Y, Arslan S, Saglam F. What is the association of primary sclerosing cholangitis with sex and inflammatory bowel disease in Turkish patients?. Hepatogastroenterology. 1998 Nov-Dec. 45(24):2064-72. [Medline].

  7. Kaplan G, Laupland K, Butzner D. Population-based study of the incidence of and the risk factors for developing primary sclerosing cholangitis. Gastroenterology. 2005. 128 (4 Suppl 2):A773.

  8. Portela F, Magro F, Lago P, et al. Ulcerative colitis in a Southern European country: A national perspective. Inflamm Bowel Dis. 2009 Oct 12. epub ahead of print. [Medline].

  9. Bjornsson E, Boberg KM, Cullen S. Patients with small duct primary sclerosing cholangitis have a favourable long term prognosis. Gut. 2002 Nov. 51(5):731-5. [Medline].

  10. Angulo P, Lindor KD. Primary sclerosing cholangitis. Hepatology. 1999 Jul. 30(1):325-32. [Medline].

  11. Ardesjo B, Portela-Gomes GM, Rorsman F, Grimelius L, Ekwall O. Identification of a novel staining pattern of bile duct epithelial cells in primary sclerosing cholangitis. Inflamm Bowel Dis. 2010 Feb. 16(2):305-11. [Medline].

  12. Baraniskin A, Nöpel-Dünnebacke S, Schumacher B, Gerges C, Bracht T, Sitek B, et al. Analysis of U2 small nuclear RNA fragments in the bile differentiates cholangiocarcinoma from primary sclerosing cholangitis and other benign biliary disorders. Dig Dis Sci. 2014 Jul. 59(7):1436-41. [Medline].

  13. Cannom RR, Kaiser AM, Ault GT, Beart RW Jr, Etzioni DA. Inflammatory bowel disease in the United States from 1998 to 2005: has infliximab affected surgical rates?. Am Surg. 2009 Oct. 75(10):976-80. [Medline].

  14. Gisbert JP. Safety of immunomodulators and biologics for the treatment of inflammatory bowel disease during pregnancy and breast-feeding. Inflamm Bowel Dis. 2009 Nov 2. epub ahead of print. [Medline].

  15. Larsen S, Bendtzen K, Nielsen OH. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med. 2010 Mar. 42(2):97-114. [Medline].

  16. Giljaca V, Poropat G, Stimac D, Gluud C. Glucocorticosteroids for primary sclerosing cholangitis. Cochrane Database Syst Rev. 2010 Jan 20. CD004036. [Medline].

  17. Karlsen TH, Schrumpf E, Boberg KM. Update on primary sclerosing cholangitis. Dig Liver Dis. 2010 Feb 19. epub ahead of print. [Medline].

  18. Mizuno S, Hirano K, Tada M, et al. Bezafibrate for the treatment of primary sclerosing cholangitis. J Gastroenterol. 2010 Feb 3. epub ahead of print. [Medline].

  19. Azeem N, Gostout CJ, Knipschield M, Baron TH. Cholangioscopy with narrow-band imaging in patients with primary sclerosing cholangitis undergoing ERCP. Gastrointest Endosc. 2014 May. 79(5):773-779.e2. [Medline].

 
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