cholestasis

Definition: 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