The chronic stage of ischemic cholangiopathy may occur in a patient who may or may not have been previously diagnosed during the acute phase. Diagnosis of the patient may be difficult if the original insult was not recognized at the time.


Clinical findings:

(1) fluctuating cholestasis and jaundice that tends to be progressive

(2) recurrent episodes of biliary sepsis

(3) pruritus


In long-standing cases secondary biliary cirrhosis may develop with portal hypertension.


Laboratory findings:

(1) cholestatic pattern with no or minimal increase in the transaminases


Cholangiography shows one or more foci of bile duct stenosis (focal or diffuse). Stenosis is often seen in the middle third of the common bile duct and at the hepatic duct confluence.


Differential diagnosis:

(1) primary sclerosing cholangitis

(2) cholangiocarcinoma

(3) primary biliary cirrhosis


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