Liver and intrahepatic bile ducts - nontumor
Biliary tract disease
Acute large duct obstruction

Author: Komal Arora, M.D. (see Authors page)

Revised: 14 November 2017, last major update May 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Acute large duct obstruction biliary

Cite this page: Arora, K. Acute large duct obstruction. website. Accessed July 21st, 2018.
Definition / general
  • Biopsies have decreased due to improved imaging
  • Usually due to gallstones in common bile duct; also bile plugs or surgical ligation
  • Associated with marked but transient increase in ALT / AST
  • Without treatment, may progress to portal fibrosis and biliary cirrhosis with loss of bile ducts
  • Note: cholestasis and ductular proliferation are nonspecific changes
Microscopic (histologic) description
  • Early: centrilobular canalicular cholestasis with edema of portal tracts, proliferation of small bile ductules (CK7+) without lumina at periphery of portal tract and neutrophils outside of the ducts, bile stasis in hepatocytes and canaliculi
  • Late: bile accumulation within ducts and ductules and possibly bile lakes (very specific); feathery degeneration of hepatocytes adjacent to areas of cholestasis, foamy and bile containing Kupffer cells; may develop portal - portal bridging fibrosis and ultimately cirrhosis with a jigsaw-like pattern
  • Lobule is not affected since injury occurs via portal tracts
Differential diagnosis
Additional references