05-12-2009, 10:38 AM
A 48-year-old man with a 11-year history of mild chronic ulcerative colitis presents with abnormal liver tests detected at time of life insurance examination. He is asymptomatic without pain, fever, pruritus, weight loss, or jaundice. He reports that his inflammatory bowel disease is quite well controlled, with occasional flares.
Physical examination shows a healthy appearing male with no vascular spiders or hepatosplenomegaly. Investigation includes a routine surveillance colonoscopy, which has not been performed in 2 to 3 years. This shows ulcerative colitis with no evidence of dysplasia on biopsies.
Laboratory tests show an alkaline phosphatase times three normal, an AST of two times normal, a normal bilirubin, albumin, and prothrombin time.
Tests to exclude other causes of liver diseases are negative.
An ultrasound shows thickening of the bile duct and of the common hepatic ducts but with no dilatation.
He undergoes an ERCP. This shows diffuse segmental dilatation and stricturing involving both the intra- and extrahepatic biliary tree.
A liver biopsy is performed.
What is the most likely findings to be seen on liver biospy?
Physical examination shows a healthy appearing male with no vascular spiders or hepatosplenomegaly. Investigation includes a routine surveillance colonoscopy, which has not been performed in 2 to 3 years. This shows ulcerative colitis with no evidence of dysplasia on biopsies.
Laboratory tests show an alkaline phosphatase times three normal, an AST of two times normal, a normal bilirubin, albumin, and prothrombin time.
Tests to exclude other causes of liver diseases are negative.
An ultrasound shows thickening of the bile duct and of the common hepatic ducts but with no dilatation.
He undergoes an ERCP. This shows diffuse segmental dilatation and stricturing involving both the intra- and extrahepatic biliary tree.
A liver biopsy is performed.
What is the most likely findings to be seen on liver biospy?