Management recommendations for chronic sickle hepatopathy
| Clinical scenario . | Clinical/investigative data . | Management recommendations . |
|---|---|---|
| Chronic cholestatic liver disease | ? History of acute crises Chronic elevation in bilirubin Exclude coincidental liver disease | Longitudinal assessment Consider regular exchange transfusion Consider ursodeoxycholic acid |
| End-stage chronic liver disease | Often biliary type cirrhosis Sclerosing cholangitis type injury reported Exclude coincidental liver disease (eg, autoimmune hepatitis) | Management of complications of cirrhosis Role of liver transplant not defined Consider if • young patient • predominant end-organ damage liver |
| Iron overload | Elevated ferritin MRI for iron concentration | Chelation when liver iron concentration >7 mg Fe/g dry weight |
| Viral hepatitis | Chronic hepatitis B virus Chronic hepatitis C virus | Treatment as per normal guidelines ? Avoidance of regimens with ribavirin for hepatitis C virus |
| Gallstone disease | Diagnosis by standard imaging techniques | Cholecystectomy-prophylactic controversial ERCP and duct clearance |
| Clinical scenario . | Clinical/investigative data . | Management recommendations . |
|---|---|---|
| Chronic cholestatic liver disease | ? History of acute crises Chronic elevation in bilirubin Exclude coincidental liver disease | Longitudinal assessment Consider regular exchange transfusion Consider ursodeoxycholic acid |
| End-stage chronic liver disease | Often biliary type cirrhosis Sclerosing cholangitis type injury reported Exclude coincidental liver disease (eg, autoimmune hepatitis) | Management of complications of cirrhosis Role of liver transplant not defined Consider if • young patient • predominant end-organ damage liver |
| Iron overload | Elevated ferritin MRI for iron concentration | Chelation when liver iron concentration >7 mg Fe/g dry weight |
| Viral hepatitis | Chronic hepatitis B virus Chronic hepatitis C virus | Treatment as per normal guidelines ? Avoidance of regimens with ribavirin for hepatitis C virus |
| Gallstone disease | Diagnosis by standard imaging techniques | Cholecystectomy-prophylactic controversial ERCP and duct clearance |
Adapted from Tavabie and Suddle5 with permission.
ERCP, endoscopic retrograde cholangiopancreatography.