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Abstract: The patient in this case is a 31-year-old young female patient who presented to the doctor with intermittent jaundice for more than 1 year. After communication with the patient, a detailed examination and cholangiogram suggested primary sclerosing cholangitis, a category of diseases that are relatively difficult to diagnose but even more difficult to treat. The patient was given medication and surgical treatment, which showed moderate short-term results, with gradual relief of symptoms, and her condition was controlled and she was discharged successfully.
Basic information】Female, 31 years old
Disease Type】Primary sclerosing cholangitis
Hospital】The First Hospital of Jilin University
Date of consultation】December 2021
Treatment plan】Surgery (cholangiography) + medication (ursodeoxycholic acid capsule) + implantation of biliary stent
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect]: The symptoms were gradually relieved, and the disease was controlled and discharged successfully.
I. Initial consultation
The patient was a young woman in her 30s, thin, with a yellowish complexion. The patient had been intermittently jaundiced for about 1 year, but the cause had not been identified, and she had been investigated for hepatitis and infectious diseases, etc. She had no previous special conditions or surgeries, and no gallbladder or bile duct stones or tumors. The patient’s enhanced CT did not suggest a definite tumor of the hepatobiliary system; MRCP bile duct water imaging showed that from intrahepatic to extrahepatic was a change in bile duct slenderness without significant dilatation, and generally speaking, if there is a surgical obstruction in a certain area, it will lead to significant bile duct dilatation. The patient was advised to continue with additional IG4 examinations and to be admitted to the hospital for cholangiography to clarify the diagnosis.
II. Treatment history
After the patient was admitted to the hospital, the first IG4 test was performed, suggesting a mild increase, and further tests were recommended. However, this test is invasive and similar to surgical treatment, requiring cholangiography under general anesthesia, which is somewhat invasive and risky, to further clarify the bile duct alignment and related diseases through the imaging results. The patient agreed and cooperated actively. Next, a cholangiogram was prepared for the patient and obtained after the injection of contrast agent under general anesthesia. The results showed that both intrahepatic and extrahepatic bile ducts were relatively slender and showed segmental stenosis, typical of primary, sclerosing cholangitis, thus clarifying the diagnosis. The treatment was done with traditional ursodeoxycholic acid capsules. In addition, a plastic biliary stent was implanted in the right side of the bile duct to relieve the symptoms of biliary stricture for adequate drainage.
III. Treatment results
After cholangiography, medication and placement of the biliary stent, the patient’s symptoms of pallor and yellowing were gradually relieved and normal diet was restored, and the patient was discharged from the hospital at 7 days of hospitalization and instructed to come back in 1 month for monthly liver function-related tests and to have the cholangiographic stent replaced if jaundice recurred. After 1 month, the patient was found to have good general symptoms, and complained of no other discomfort and a rosy complexion, indicating a good treatment effect.
IV. Precautions
Through the patient’s active cooperation, the patient’s recovery status after treatment is optimistic and we are happy for him. However, it is necessary to pay close attention to whether there is recurrence of clinical symptoms, such as intermittent fever, jaundice, nausea and vomiting, after discharge from the hospital. Regular review after discharge, liver function recheck every month to clarify bilirubin and transaminase levels. The hepatobiliary and pancreatic CT should be reviewed 3 months after discharge to clarify the changes in the bile ducts and the stenotic segments. After discharge from the hospital, choose biliary drugs as prescribed by the doctor, and ursodeoxycholic acid capsules were routinely chosen. In daily life, we should eat a reasonable diet, mainly high protein and nutritious food, recommend fresh fruits and vegetables, and actively control weight and exercise appropriately.
V. Personal insight
Primary sclerosing cholangitis is a type of autoimmune system disease that is relatively difficult to diagnose. Due to the insidious onset of the disease, clinical symptoms are usually found over a long period of time, and common clinical symptoms include intermittent jaundice, fever, abdominal pain, etc. Symptoms are generally atypical and require close daily observation. The diagnosis of primary sclerosing cholangitis includes MRCP biliary hydrography and enhanced CT examination, but there are limitations in non-invasive examination means, and cholangiography is commonly used for clear diagnosis in clinical practice, so cholangiography is currently, the gold standard for the diagnosis of primary sclerosing cholangitis. And the treatment usually includes medication and surgery, often with ursodeoxycholic acid capsules, and surgical treatment with endoscopic biliary drainage. In addition to the necessary treatment, patients should adhere to long-term follow-up. Usually after aggressive and effective treatment, as in this patient, the condition can be brought into effective remission.