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

Topic Completed: 1 May 2012

Revised: 25 April 2019

Revised: 23 January 2019, last major update May 2012

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

PubMed Search: Acute large duct obstruction biliary

Komal Arora, M.D.
Page views in 2018: 843
Page views in 2019 to date: 681
Cite this page: Arora K. Acute large duct obstruction. website. Accessed September 20th, 2019.
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
Back to top