Perioperative Risk Assessment
Fig. 2.1 Cardiac evaluation and cardiac care prior to noncardiac surgery. *Noninvasive testing may be considered before surgery in specific patients with risk factors if it will change the management….
Primary Sclerosing Cholangitis
Fig. 4.1 Survival in patients with small-duct and large-duct PSC. Survival free of liver transplantation is significantly longer in patients with small-duct PSC. Modified from Bjornsson et al. Gastroenterology 2008;134(4)…
Endoscopic Management of Biliary Obstruction
Diagnostic Primary sclerosing cholangitis Indeterminate biliary strictures Sphincter of Oddi manometry Patient with contraindications to noninvasive imaging Therapeutic Common bile duct stones Benign biliary strictures Malignant biliary strictures Primary sclerosing…
IgG4 Related Cholangitis
Fig. 5.1 Schematic representation of the current hypotheses on the aetiopathogenesis of IgG4-RD and IAC. (With thanks to WouterSmit (AMC, Amsterdam) for his contribution in illustrating this figure) Role of…
Cholestatic Variants of Viral Disease and Alcohol
Fig. 7.1 Mild hepatocanalicular cholestasis (arrow) in a patient with acute Hepatitis A virus infection. Note the background lobular disarray and inflammation. H and E, 600×. (Courtesy of Maxwell L….
Cholestasis in the Hospitalized Patient
Primary biliary cirrhosis (PBC) Primary sclerosing cholangitis (PSC) Autoimmune sclerosing cholangitis Granulomatous hepatitis Hepatic amyloidosis Congestive hepatopathy Hepatic sarcoidosis Systemic viral infections • Hepatitis Viruses (A, B, C, D, E) • Cytomegalovirus…
Cholestasis Post-Liver Transplantation
Early (<6 months) Late (>6 months) Extrahepatic: Extrahepatic: Stricture—single (anastomotic, external compression) Benign stricture—single (anastomotic) Stricture—multiple (HAT/ischemic) Multiple (HAT/ischemic, rPSC) Biliary leak Stones Cholangitis Intrahepatic: Intrahepatic: Preservation/reperfusion injury Acute cellular…
Cholestasis Related to Systemic Disorders
Canalicular impairment Sepsis Hormone mediated cholestasis (intrahepatic cholestasis of pregnancy) Congestive hepatopathy Paraneoplastic cholestasis Systemic amyloidosis Sickle cell disease Small intrahepatic bile ducts obstruction Sarcoidosis Rheumatological diseases Cystic fibrosis Graft…
Complications of Cholestasis
Drug/therapy Dosage Efficacy proven in controlled trials Cholestyramine 4–16 g/day (PO) Rifampicin 300–600 mg/day (PO) adult 10 mg/kg/day (PO) child Naltrexone 25–50 mg/day (PO) Naloxone 0.2 μg/kg/min (IV) Sertraline 75–100…
Diagnosis of Cholestasis
Anabolic steroids, estrogens Amoxicillin–clavulanic acid Azathioprine Cetirizine Chlorpromazine Cyclosporin Dapsone Diltiazem Erythromycin Fenofibrate Floxuridine Gold salts Infliximab Itraconazole Metolazone Nitrofurantoin Oral contraceptives Phenytoin Rifampicin Trimethoprim–sulfamethoxazole 5-Fluorouracil or floxuridine A history…
