Hepatobiliary disorders in IBD
| Disease | Clinical presentation | Diagnosis | Prevalence (CD vs UC) | Management | Complications |
| Primary sclerosing cholangitis | Asymptomatic Pruritus Fatigue Weight loss Hepatomegaly Splenomegaly Jaundice Cholangitis | Biochemical markers of cholestasis MRCP/ERCP Liver biopsy (concentric fibrosis, onion-skin) | UC>CD | Symptomatic relief Treat complications Liver transplantation | Cirrhosis Liver failure Portal hypertension Cholangitis Cholangiocarcinoma Colorectal cancer Gallbladder stones and malignancy |
| Autoimmune hepatitis | Asymptomatic to acute liver failure Fatigue Weight loss Fever Hepatomegaly Abdominal pain Splenomegaly Jaundice | Increased hepatocellular enzymes High IgG Autoantibodies (ANA, ASMA, anti-LKM, anti-SLA) Liver biopsy (interface hepatitis) | N/A | Immunosuppressants (steroids, azathioprine) | Cirrhosis Liver failure Portal hypertension Hepatocellular carcinoma |
| IgG4-related cholangitis | Cholangitis Pruritus Jaundice Abdominal pain | High serum IgG4 level Liver biopsy (IgG4-positive plasma cells) | N/A | Steroids Immunomodulators | Cirrhosis Liver failure Portal hypertension |
| Granulomatous hepatitis | Asymptomatic Fever Abdominal pain Hepatomegaly Splenomegaly | Biochemical markers of cholestasis Liver biopsy (granuloma formation) | CD~UC | Treat underlying cause Glucocorticoids | Liver failure (rare) |
| Hepatic amyloidosis | Asymptomatic Abdominal pain Hepatomegaly | Elevated ALK-P levels Liver biopsy (positive congo red stain) | CD>UC | Treat underlying cause Colchicine | Rare |
| Cholelithiasis | Asymptomatic Cholecystitis Cholangitis | Elevated cholestatic liver enzymes Ultrasound (thickened bladder wall, dilated bile ducts) | CD>UC | Cholecyctectomy (in case of complications) | Cholecystitis Cholangitis Pancreatitis |
| Non-alcoholic fatty liver disease | Asymptomatic Hepatomegaly | Elevated hepatocellular enzymes Ultrasound (echogenic liver) Liver biopsy | N/A | Treat metabolic syndrome Withdraw steroids and MTX | Cirrhosis Liver failure Portal hypertension Hepatocellular carcinoma |
| Pyogenic liver abscess | Fever Abdominal pain Constitutional symptoms | US/CT Elevated cholestatic enzymes | CD>UC | Antibiotics Drainage | Rupture and sepsis |
| Portal vein thrombosis | Asymptomatic Abdominal pain Fever | US Doppler CT | CD~UC | Portal hypertension Variceal bleeding | Anticoagulation |
ALK-P, alkaline phosphatase; ANA, antinuclear antibody; ASMA, antismooth muscle antibody; CD, Crohn’s disease; LKM, liver kidney microsomal antibody; MTX, methotrexate; SLA, soluble liver antigen; UC, ulcerative coliti; US, ultrasound.