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Ischemic Cholangiopathy

By

Whitney Jackson

, MD, University of Colorado School of Medicine

Last full review/revision May 2020
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Topic Resources

Ischemic cholangiopathy is damage to one or more bile ducts caused by inadequate blood flow.

Bile ducts (such as the hepatic ducts and the common bile duct), unlike the liver, are supplied with blood from only one major blood vessel, the hepatic artery. Thus, disruption of blood flow through the hepatic artery can prevent the bile ducts from obtaining enough oxygen. Consequently, the cells lining the ducts are damaged or die—a disorder called ischemic cholangiopathy. Blood flow can be disrupted when

Symptoms of Ischemic Cholangiopathy

The damaged bile duct becomes inflamed, narrows (causing a stricture), or both. Then the flow of bile slows or is blocked. If bile cannot move through the liver and bile ducts quickly enough, the pigment in bile (bilirubin) builds up in the blood and is deposited in the skin. As a result, the skin and the whites of the eyes turn yellow (called jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more Jaundice in Adults ). The narrowing or blockage can prevent bile (which contains pigments such as bilirubin) from entering the small intestine and being eliminated in stool. As a result, the stools become pale, and because more bile is eliminated in urine, the urine becomes dark.

Itching (pruritus) is common, often beginning in the hands and feet but usually affecting the whole body. Itching is especially worse at night. Bile duct infection (cholangitis Symptoms Primary sclerosing cholangitis is inflammation with progressive scarring and narrowing of the bile ducts in and outside the liver. Eventually, the ducts become blocked and then obliterated.... read more ) may also occur, producing abdominal pain, chills, and fever.

Diagnosis of Ischemic Cholangiopathy

  • History of a predisposing condition (for example, liver transplant)

  • A doctor's evaluation

  • Blood tests and imaging studies

The diagnosis is based on the symptoms and abnormal blood test results, especially in people who have conditions that make ischemic cholangiopathy more likely (such as liver transplant Liver Transplantation Liver transplantation is the surgical removal of a healthy liver or sometimes a part of a liver from a living person and then its transfer into a person whose liver no longer functions. (See... read more recipients).

Ultrasonography helps doctors visualize the ducts, but the results may be inconclusive. Better definition often requires magnetic resonance imaging of the bile ducts (a procedure called magnetic resonance cholangiopancreatography, or MRCP) or endoscopic retrograde cholangiopancreatography Imaging Tests of the Liver and Gallbladder Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, radionuclide scanning, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more (ERCP). ERCP involves inserting a flexible viewing tube (endoscope) through the mouth and into the small intestine and injecting a contrast agent into the bile duct system.

Treatment of Ischemic Cholangiopathy

  • Endoscopic retrograde cholangiopancreatography (ERCP) and stenting

  • Change in drugs (in people with liver transplants)

In addition to detecting narrowing of the bile ducts, ERCP can be used to treat strictures. A wire with a deflated balloon at its end is introduced through the endoscope. Doctors inflate the balloon to widen (dilate) narrowed areas. A mesh tube (stent) is then inserted to keep the duct open.

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Imaging Tests of the Liver and Gallbladder
There are several different types of tests for imaging the liver, gallbladder, and bile ducts. Which of the following is the least expensive and safest technique for obtaining images of these structures?
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