The association between asymptomatic primary sclerosing cholangitis and exocrine pancreatic disease was underlined by the findings in a patient with cystic fibrosis and in another with chronic pancreatitis. In each case hepatocytes showed extensive microvesicular steatosis and studies of drug metabolism suggested hepatic enzyme induction: biliary or serum analysis, or both, disclosed raised concentrations of a lipid-based marker of free radical oxidation. These findings suggest that toxic metabolites of oxygen or other chemicals may have a role in the pathogenesis of the bile duct lesion.
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