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Liver and intrahepatic bile ducts-nontumor

Biliary tract disease

Acute large duct obstruction


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 21 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● 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 non-specific changes

Micro description
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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

Micro images
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Figures A/B

Differential diagnosis
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● Sepsis (neutrophils present within lobules as well as portal areas), drug reaction, treated liver transplant rejection, hyperalimentation toxicity

Additional references
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J Clin Pathol 1994;47:457

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


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