| Abstract [eng] |
Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease, are chronic immune-mediated conditions that often extend beyond the gastrointestinal tract, causing systemic complications. Among the most common extraintestinal manifestations of IBD are various liver and biliary tract disorders. This paper analyzes the most relevant liver diseases associated with IBD: primary sclerosing cholangitis (PSC), cholelithiasis, drug-induced liver injury and non-alcoholic fatty liver disease. The clinical case of PSC is discussed, along with the pathogenesis, clinical features, diagnostics, and treatment principles of the aforementioned diseases Primary sclerosing cholangitis (PSC) is a rare, progressive autoimmune liver disease that affects both intrahepatic and extrahepatic bile ducts, leading to fibrosis, strictures, cholestasis, and ultimately liver cirrhosis. Characteristic findings include an “onion-skin” pattern on liver biopsy, elevated cholestatic enzymes (ALP, GGT), and segmental bile duct strictures seen on MR cholangiography (“beaded” appearance). PSC is often associated with inflammatory bowel disease, particularly ulcerative colitis. Treatment is mostly symptomatic, typically involving ursodeoxycholic acid (UDCA), while besofibrate or rifampicin may be used to manage pruritus. In advanced cases, liver transplantation may be required. The clinical case presented illustrates a typical PSC course: a 40-year-old woman with ulcerative colitis experienced symptoms of cholestasis, elevated liver enzymes, and MR imaging revealed intrahepatic bile duct strictures. As the disease progressed, the characteristic “beaded” appearance involving both intrahepatic and extrahepatic ducts became evident. After diagnosis was confirmed by biopsy, UDCA therapy was initiated. The disease followed a classic progression—from mild symptoms to cirrhosis over nearly two decades—ultimately requiring liver transplantation. This case highlights the importance of early recognition of PSC in patients with ulcerative colitis, as the disease can progress silently with minimal symptoms. Clinical guidelines emphasize the value of imaging and regular monitoring. The case also illustrates the limitations of UDCA treatment—although initial symptoms improved, the disease continued to progress, underscoring transplantation as the only definitive treatment for advanced PSC. |
