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Cholestasis

Wednesday 4 June 2003

In morphological terms, cholestasis is the presence of visible bile in tissue sections. It is also known as bilirubinostasis because the main component seen by light microscopy is bilirubin.

Bile is rarely seen in normal liver, and then only in minute amounts; cholestasis should therefore be regarded as pathological.

The location of the bile varies. The commonest is in dilated bile canaliculi between hepatocytes. This canalicular form of cholestasis, sometimes called acute cholestasis, may be accompanied by bile accumulation in the cytoplasm of hepatocytes and Kupffer cells. Canalicular cholestasis is typically perivenular.

In contrast, in patients with chronic biliary tract disease, bile may accumulate in periportal hepatocytes. This is also known as cholate stasis because abnormal bile salts are thought to contribute to its pathogenesis.

In large bile-duct obstruction in adults, bile is not usually visible under the microscope within canals of Hering, bile ductules or bile ducts even though the biliary tree may be dilated.

The commonest cause of ductular cholestasis is sepsis.

Dense bile is also visible in ducts in different forms of ductal plate malformation and in extrahepatic biliary atresia.

Morphological synopsis

- hepatocellular cholestasis

  • bile-laden Kupffer cells

- canalicular cholestasis

  • canalicular bile plugs

- ductular cholestasis
- ductal cholestasis

Topography

- portal cholestasis
- lobular cholestasis
- centrilobular cholestasis

Clinical types

- acute cholestasis
- chronic cholestasis
- familial cholestasis
- neonatal cholestasis

Etiology (exemples)

- obstructive cholestasis
- drug-induced cholestasis

See also

- bile

References

- Arrese M, Trauner M. Molecular aspects of bile formation and cholestasis. Trends Mol Med. 2003 Dec;9(12):558-64. PMID: #14659471#

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