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Update on Sclerosing Cholangitis in Critically Ill Patients
Gabriele I Kirchner1, Petra Rümmele2
1Department of Internal Medicine I, University Hospital of Regensburg, Regensburg, Germany.
Sclerosing cholangitis in critically ill patients (SC-CIP) is a rare, rapidly progressing liver disease. Early exclusion via ERCP and evaluation for liver transplantation are crucial due to poor prognosis.
Area of Science:
- Hepatology
- Critical Care Medicine
- Gastroenterology
Background:
- Sclerosing cholangitis in critically ill patients (SC-CIP) is a prevalent form of secondary sclerosing cholangitis.
- Its etiology remains largely unknown, presenting as a significant clinical challenge.
Purpose of the Study:
- To provide a comprehensive overview of SC-CIP.
- To highlight diagnostic and therapeutic considerations for this rare liver disease.
Main Methods:
- Systematic literature review using PubMed.
- Keywords included 'secondary sclerosing cholangitis', 'SC-CIP', 'cast syndrome', and 'ischemic cholangitis'.
Main Results:
- SC-CIP develops in sepsis patients with ARDS during long-term ICU care, rapidly progressing to cirrhosis and liver failure.
- Pathogenesis involves ischemic biliary injury, leading to stenosis, casts, and infections, often with multi-resistant bacteria.
- Risk factors include mechanical ventilation, prone positioning, and increased intraperitoneal fat; prognosis is poor, with liver transplantation (LT) as the only cure.
Conclusions:
- SC-CIP must be excluded in sepsis patients with prolonged ICU stays and cholestasis, using ERCP.
- Given the grave prognosis, LT should be considered for all SC-CIP patients.
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