Surgery>>>>>The Gallbladder and Extrahepatic Biliary System
Question 10#

Appropriate management of a patient with cirrhosis secondary to sclerosing cholangitis includes:

A. Systemic immunosuppression with corticosteroids and calcineurin inhibitors
B. Anti-tumor necrosis factor (TNF) monoclonal antibodies (infliximab)
C. Consideration for transplantation
D. Ursodeoxycholic acid
E. Excision of the extrahepatic biliary tree (Kasai procedure)

Correct Answer is C

Comment:

Sclerosing cholangitis (primary or secondary) is an uncommon disease characterized by inflammatory strictures involving the intrahepatic and extrahepatic biliary tree. It is a progressive disease which can lead to biliary cirrhosis. Medical therapy has long been attempted with immunosuppressants, antibiotics, steroids, and ursodeoxycholic acid, and has been disappointing. Surgical management with resection of the extrahepatic biliary tree and hepaticojejunostomy has produced reasonable results in patients with extrahepatic and bifurcation strictures, but without cirrhosis or significant hepatic fibrosis. In patients with sclerosing cholangitis and advanced liver disease, liver transplantation is the only option. It offers excellent results, with overall 5-year survival as high as 85%. Primary sclerosing cholangitis recurs in 10 to 20% of patients and may require retransplantation.