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HIV-associated cholangitis
Etiology:
1) cytomegalovirus
2) cryptosporidia
3) microsporidia
4) HIV1 itself
Pathology:
1) cholangitis of extrahepatic bile ducts
2) ductal irregularity & narrowing
Clinical manifestations:
1) right upper quadrant or gastric pain (most patients)
a) frequently severe enough to require narcotics
b) generally described as sharp
c) may radiate to back
2) nausea & vomiting (50%)
3) fever (50%)
4) cholestasis
Laboratory:
1) serum alkaline phosphatase 5X upper limit of reference interval
2) serum transaminases 2-3X upper limit of reference interval
3) serum bilirubin normal or slighly elevated
Radiology:
1) 4 distinct patterns
a) papillary stenosis
b) sclerosis cholangitis
c) long strictures of extrahepatic bile ducts
d) combined stenosis & cholangitis (most common)
Differential diagnosis:
- pancreatitis
Management:
1) analgesia
- opiates
2) percutaneous biliary drainage
Related
human immunodeficiency virus (HIV)
General
HIV1/AIDS-associated hepatobiliary disorder
cholangitis
References
- Internal Medicine World Report 20(7) July 2005
- Mahajani RV, Uzer MF.
Cholangiopathy in HIV-infected patients.
Clin Liver Dis. 1999 Aug;3(3):669-84, x. Review.
PMID: 11291244
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998