Y2 W18 S1 - Cholestasis

Front 1

Cholestasis: Definition

Back 1

Impaired bile formation & flow, leading to accumulation of bile pigment in hepatic parenchyma.

Front 2

Cholestasis: Causes

Back 2

Gallstones (most common)
or
Primary biliary cirrhosis.
-> Extrahepatic or intrahepatic obstruction of bile channels,
or
Defects in hepatocyte bile secretion.

Front 3

Cholestasis: Pathology

Back 3

Accumulation of bile pigment within the hepatic parenchyma.

Elongated green-brown plugs visible in dilated bile canaliculi.

Rupture of canaliculi can lead to extravasation of bile, which are quickly phagocytosed by Kupffer cells.

Changes:
1) Cholestatic hepatocytes are enlarged with...
2) Dilated canalicular spaces
3) Apoptotic cells
4) Kupffer cells containing regurgitated bile pigment
5) Edema
6) Bile pigment retention (not illustrated: can lead to neutrophilic inflammation)
7) Surrounding hepatocytes are swollen and undergoing degeneration

Front 4

Cholestasis: Clinical Features

Back 4

Jaudice,
pruritis,
skin xanthomas,
intestinal malabsorption symptoms (nutritional deficiency etc.)

Front 5

Cholestasis: Investigations

Back 5

Raised serum ALP and gammaGT:
Enzymes present on apical membranes of hepatocytes and bile duct epithelial cells.

Front 6

Cholestasis: Tx

2 types: Extrahepatic and Intrahepatic

Back 6

Extrahepatic:
Surgical alleviation (correct, prompt diagnosis is imperative

Intrahepatic:
Not benefited (sometimes made worse) by surgery (except transplant)