(See also Overview of Blood Vessel Disorders of the Liver Overview of Blood Vessel Disorders of the Liver The liver receives the oxygen and nutrients it needs in blood that comes from two large blood vessels: Portal vein Hepatic artery The portal vein provides about two thirds of the blood. This... read more .)
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
A liver transplant is rejected.
Blood vessels are injured during liver transplantation surgery or removal of the gallbladder by laparoscopy.
Blood vessels are injured by radiation therapy.
People have a disorder that makes blood more likely to clot (blood clotting disorder Overview of Blood Clotting Disorders Blood clots help stop bleeding. Blood clotting (coagulation) disorders are dysfunctions in the body's ability to control the formation of blood clots. These dysfunctions may result in Too little... read more ).
A procedure that is done to block blood flow to a tumor in the liver (called chemoembolization) also blocks blood flow to healthy tissue.
Ischemic cholangiopathy most commonly occurs in people who have had a 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 .
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 ). 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, 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.
If people have had a 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 , the drugs they take to prevent rejection may need to be changed, or they may require another transplant.