Hepatic complications of ibd
Advertisement
This presentation is the property of its rightful owner.
1 / 30

HEPATIC COMPLICATIONS OF IBD PowerPoint PPT Presentation

HEPATIC COMPLICATIONS OF IBD. Preeti A. Reshamwala, MD University of Maryland Medical Center Division of Gastroenterology and Hepatology. ABNORMAL HEPATIC BIOCHEMISTRIES IN IBD PATIENTS. HEPATIC COMPLICATIONS OF IBD. Alcoholic liver disease Viral hepatitis Primary Sclerosing Cholangitis

Related searches for HEPATIC COMPLICATIONS OF IBD

Download Presentation

HEPATIC COMPLICATIONS OF IBD

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Hepatic complications of ibd

HEPATIC COMPLICATIONS OF IBD

Preeti A. Reshamwala, MD

University of Maryland Medical Center

Division of Gastroenterology and Hepatology


Abnormal hepatic biochemistries in ibd patients

ABNORMAL HEPATIC BIOCHEMISTRIES IN IBD PATIENTS


Hepatic complications of ibd1

HEPATIC COMPLICATIONS OF IBD

  • Alcoholic liver disease

  • Viral hepatitis

  • Primary SclerosingCholangitis

  • Nonalcoholic fatty liver disease

  • Medications/Drug Induced Liver Injury

  • Autoimmune Hepatitis

  • Nodular Regenerative Hyperplasia

  • Primary Biliary Cirrhosis

  • Portal Vein Thrombosis/Hepatic Vein Thrombosis


Hepatic complications of ibd2

HEPATIC COMPLICATIONS OF IBD

Alcoholic liver disease

Viral hepatitis

Primary SclerosingCholangitis

Nonalcoholic fatty liver disease

Medications/Drug Induced Liver Injury

Autoimmune Hepatitis

Nodular Regenerative Hyperplasia

Primary Biliary Cirrhosis

Portal Vein Thrombosis/Hepatic Vein Thrombosis


Hepatic complications of ibd3

HEPATIC COMPLICATIONS OF IBD

Alcoholic liver disease

Viral hepatitis

Primary SclerosingCholangitis

Nonalcoholic fatty liver disease

Medications/Drug Induced Liver Injury

Autoimmune Hepatitis

Nodular Regenerative Hyperplasia

Primary Biliary Cirrhosis

Portal Vein Thrombosis/Hepatic Vein Thrombosis


Primary sclerosing cholangitis

PRIMARY SCLEROSING CHOLANGITIS

  • Most firmly established hepatobiliary disease associated with IBD

  • 70-80% cases associated with IBD

  • 87% = UC; 13% = Crohns disease

  • Prevalence of PSC in UC range from 2.4% to 7.5%


Primary sclerosing cholangitis1

PRIMARY SCLEROSING CHOLANGITIS

  • Progressive inflammation, fibrosis, destruction of bile ducts

  • Intrahepatic and extrahepatic bile ducts

  • Can result in portal hypertension and cirrhosis


Primary sclerosing cholangitis2

PRIMARY SCLEROSING CHOLANGITIS


Psc pathogenesis

PSC - PATHOGENESIS

  • Genetic susceptibility

  • Chronic portal bacteremia

  • Viral infection

  • Ischemic vascular damage

  • Immune dysregulation


Psc diagnosis

PSC - DIAGNOSIS

  • Clinical symptoms

  • Biochemical abnormalities

  • Histological findings

  • Cholangiographic findings


Psc treatment

PSC - TREATMENT

  • ? UDCA

  • Management of strictures/infections

  • Management of portal hypertension

  • Orthotopic liver transplantation

  • Cholangiocarcinoma: 6-11% of PSC patients


Nonalcoholic fatty liver disease

NONALCOHOLIC FATTY LIVER DISEASE


Nonalcoholic fatty liver disease1

NONALCOHOLIC FATTY LIVER DISEASE

  • Hepatomegaly and steatosis = 25-40% of all IBD patients

    • Corticosteroid use

    • Malnutrition

    • Fluctuation in weight

    • Concomitant diseases

  • Treatment – avoid steroid medications, diet and lifestyle modification


Autoimmune hepatitis

AUTOIMMUNE HEPATITIS

  • < 5% associated with IBD

  • Features of AIH found as “overlap syndrome” with PSC

  • Predominantly children

  • Standard diagnostic criteria


Autoimmune hepatitis1

AUTOIMMUNE HEPATITIS


Drug induced liver injury

DRUG INDUCED LIVER INJURY

  • Antibiotics

  • 5 – ASA

  • Corticosteroids

  • Thioguanine

  • 6-mercaptopurine

  • Infliximab

  • Methotrexate

  • Cyclosporine


Drug induced liver injury1

DRUG INDUCED LIVER INJURY

  • Multiple medications used

  • DILI 14-40% IBD series

  • Role of metabolite monitoring

  • Drug withdrawal – if possible

  • Histology


Nodular regenerative hyperplasia

NODULAR REGENERATIVE HYPERPLASIA

  • Nodular noncirrhotic liver disease

  • Believed to be a result of microcirculatory abnormalities leading to hypertrophy in some acini, atrophy in others

  • NO FIBROSIS

  • Mimics cirrhosis, associated with portal hypertension


Nodular regenerative hyperplasia1

NODULAR REGENERATIVE HYPERPLASIA


Nodular regenerative hyperplasia2

NODULAR REGENERATIVE HYPERPLASIA

  • Associated with use of TG

  • 20-55% of liver biopsies of patients on TG therapy

  • Pathogenesis - ?non-necrotizing endothelitis vascular abnormalities

  • 1/3 of patients will have abnormal aminotransferases or alkaline phosphatase

  • Hepatic synthetic function usually preserved


Nodular regenerative hyperplasia3

NODULAR REGENERATIVE HYPERPLASIA

  • Treatment – drug withdrawal

  • Management of portal hypertension


Primary biliary cirrhosis

PRIMARY BILIARY CIRRHOSIS

  • Rarely associated with IBD

  • Reported <2% patients with IBD

  • Rule out other cholestatic liver diseases, granulomatous liver diseases, infections

  • Antimitochondrial antibody

  • HISTOLOGY


Thromboembolic phenomena

THROMBOEMBOLIC PHENOMENA

  • IBD patients – predisposition for hypercoagulable state

  • Reports of acute portal vein thrombosis and hepatic vein thrombosis – children

  • Often associated with septic pyelophlebitis

  • Chronic PVT/HVT can lead to portal hypertension and cirrhosis

  • Anticoagulation may be considered


Conclusions

CONCLUSIONS

  • Monitor hepatic biochemistries

  • Eliminate alcohol use

  • Treat viral hepatitis

  • Recognize and limit the use of hepatotoxic drugs – difficult task

  • If no improvement in hepatic profile, biopsy is essential

  • Referral to hepatologist +/- transplant center


  • Login