Cholestasis - Revision history

Michael: touch

2016-02-08T03:26:49Z

touch

← Older revision		Revision as of 03:26, 8 February 2016
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	In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.		In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.

	'''Cholestatic hepatitis''' and '''feathery degeneration''' redirect to this article.		'''Cholestatic hepatitis''' and '''feathery degeneration''' redirect to this article.

	==General==		==General==

Michael at 23:00, 3 January 2016

2016-01-03T23:00:02Z

← Older revision		Revision as of 23:00, 3 January 2016
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	[[Image:Cholestasis_high_mag.jpg\|thumb\|right\|300px\|~~Cholestasis~~. [[H&E stain]]. (WC)]]		[[Image:Cholestasis_high_mag.jpg\|thumb\|right\|300px\|Micrograph showing cholestasis, as is apparent by the yellow bile. [[H&E stain]]. (WC)]]
	In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.		In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.

Michael at 22:57, 3 January 2016

2016-01-03T22:57:47Z

← Older revision		Revision as of 22:57, 3 January 2016
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			[[Image:Cholestasis_high_mag.jpg\|thumb\|right\|300px\|Cholestasis. [[H&E stain]]. (WC)]]
	In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.		In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.

Michael: /* General */

2016-01-03T22:52:35Z

General

← Older revision		Revision as of 22:52, 3 January 2016
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	*Dark urine and light stools.		*Dark urine and light stools.

	Short DDx - by etiology:		===Short DDx - by etiology===
	*Congenital: Bile duct cyst, biliary atresia, liver cysts.		*Congenital: Bile duct cyst, biliary atresia, liver cysts.
	*Infectious: Worm.		*Infectious: Worm.
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	*Endocrine: cholestasis of pregnancy.		*Endocrine: cholestasis of pregnancy.
	*Trauma -> sepsis.		*Trauma -> sepsis.
	*Autoimmune: PSC, PBC.		*Autoimmune: [[primary sclerosing cholangitis\|PSC]], [[primary biliary cirrhosis\|PBC]].
	*Toxins: alcohol -> cirrhosis.		*Toxins: [[alcoholic liver disease\|alcohol]] -> [[cirrhosis]].
	*Everything else: drugs, e.g. [[NSAID]]s.		*Everything else: drugs, e.g. [[NSAID]]s.

	Short DDx - structural:		===Short DDx - structural===
	*Obstruction - large duct:		*Obstruction - large duct:
	**Tumour.		**Tumour.
	**Gallstone.		**[[Gallstone]].
	**Worm.		**Worm.
	**PSC.		**PSC.

Michael at 22:50, 3 January 2016

2016-01-03T22:50:24Z

← Older revision		Revision as of 22:50, 3 January 2016
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	In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.		In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.

	'''Cholestatic hepatitis''' ~~redirects~~ to this article.		'''Cholestatic hepatitis''' and '''feathery degeneration''' redirect to this article.

	==General==		==General==

Michael at 22:48, 3 January 2016

2016-01-03T22:48:48Z

← Older revision		Revision as of 22:48, 3 January 2016
Line 1:		Line 1:
	In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.		In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.

			'''Cholestatic hepatitis''' redirects to this article.

	==General==		==General==

Michael: split out

2016-01-03T22:47:16Z

split out

← Older revision		Revision as of 22:47, 3 January 2016
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	#~~redirect~~ [[Liver pathology~~#Cholestasis~~]]		In [[liver pathology]], '''cholestasis''' is a stoppage or abnormally slow flow of bile.

			==General==
			Clinical - classic:<ref>URL: [http://www.patient.co.uk/doctor/cholestasis http://www.patient.co.uk/doctor/cholestasis]. Accessed on: 28 November 2013.</ref>
			*Dark urine and light stools.

			Short DDx - by etiology:
			*Congenital: Bile duct cyst, biliary atresia, liver cysts.
			*Infectious: Worm.
			*Tumour: pancreas, bile duct, liver.
			*Endocrine: cholestasis of pregnancy.
			*Trauma -> sepsis.
			*Autoimmune: PSC, PBC.
			*Toxins: alcohol -> cirrhosis.
			*Everything else: drugs, e.g. [[NSAID]]s.

			Short DDx - structural:
			*Obstruction - large duct:
			**Tumour.
			**Gallstone.
			**Worm.
			**PSC.
			*Small duct - autoimmune:
			**PBC.
			*Other:
			**Rx.
			**Toxins.
			**Cholestasis of pregnancy.

			==Microscopic==
			Appearance of bile:
			*Smooth/homogenous.
			*Brown/yellow.
			*Globule/droplet - that is larger than an iron granule.

			Note:
			*Iron in bile ducts or endothelial cell = non-specific, used to be thought to be specific for [[hereditary hemochromatosis]].

			===Brown/yellow cytoplasmic inclusions===
			Comparison of brown/yellow cytoplasmic inclusions:<ref>Guindi, M. September 2009.</ref>
			{\| class="wikitable sortable" border="1"
			! Finding
			! Colour
			! Granularity
			! Refractile
			! Usual location
			! Association
			! Stain
			! Image
			\|-
			\| Iron\|\|Brown\|\|Coarse granules\|\|Yes - shinny\|\|Periportal<br>(zone I)\|\|Hemolysis, hereditary hemochromatosis \|\| [[Prussian blue stain\|Prussian blue]] +ve \|\| [[Image:Sickle_cell_disease_and_cirrhosis_-_very_high_mag.jpg\|thumb\|center\|100px\|Iron and bile. (WC)]]
			\|-
			\| Bile\|\|Brown - coffee stained\|\|Not granular\|\|No - dull\|\|Portal\|\|Duct injury/obstruction
			\| None \|\| [[Image:Cholestasis_high_mag.jpg\|thumb\|100px\|center\|Bile. (WC)]]
			\|-
			\| Lipofuscin\|\|Yellow\|\|Fine granules\|\|No\|\|Centrilobular<br>(zone III)\|\|Advanced age \|\| [[PAS stain]] +ve \|\| [[Image:Ground_glass_hepatocytes_high_mag_cropped.jpg\|thumb\|100px\|center\|Lipofuscin. (WC)]]
			\|-
			\|}

			===Large duct obstruction===
			Histologic findings of large-duct obstruction:<ref>{{Ref MacSween\|565}}</ref>
			#Perivenular bilirubinostasis.
			#Portal tract edema & inflammation (neutrophils & macrophages).
			#Large bile plugs.
			#Bile duct proliferation.<ref name=pmid7439807>{{cite journal \|author=Chapman RW, Arborgh BA, Rhodes JM, ''et al.'' \|title=Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology \|journal=Gut \|volume=21 \|issue=10 \|pages=870–7 \|year=1980 \|month=October \|pmid=7439807 \|pmc=1419383 \|doi= \|url=}}</ref><ref name=pmid14594129>{{cite journal \|author=Leuschner U \|title=Primary biliary cirrhosis--presentation and diagnosis \|journal=Clin Liver Dis \|volume=7 \|issue=4 \|pages=741–58 \|year=2003 \|month=November \|pmid=14594129 \|doi= \|url=}}</ref>

			Note:
			*''Ductular reaction'' = increased number of ducts + [[neutrophil]]s.<ref name=pmid9845427>{{Cite journal \| last1 = Roskams \| first1 = T. \| last2 = Desmet \| first2 = V. \| title = Ductular reaction and its diagnostic significance. \| journal = Semin Diagn Pathol \| volume = 15 \| issue = 4 \| pages = 259-69 \| month = Nov \| year = 1998 \| doi = \| PMID = 9845427 }}</ref>

			===Small duct obstruction===
			Small-duct obstruction:
			*Abnormal liver plate architecture. (???)

			====Images====
			<gallery>
			Image:Cholestasis_high_mag.jpg \| Cholestasis. (WC/Nephron)
			</gallery>
			www:
			*[http://www.humpath.com/spip.php?article4340&id_document=20040 Centrilobular cholestasis (humpath.com)].

			==Sign out==
			<pre>
			LIVER, CORE BIOPSY:
			- CENTRILOBULAR CHOLESTATSIS (MILD), SEE MICROSCOPIC DESCRIPTION AND COMMENT.
			- NEGATIVE FOR FIBROSIS.

			COMMENT:
			There is no apparent feathery degeneration. There is no bile ductular proliferation. No
			definite onion-skin lesions are identified.

			The centrilobular distribution of the bile favours a large duct obstruction. Possible
			causes include gallstones, other obstructing lesions, herbals and drugs.

			Clinical and radiologic correlation is suggested.
			</pre>

			==See also==
			*[[Ballooning degeneration]].
			*[[Drug-induced liver injury]].

			==References==
			{{reflist\|1}}

			[[Category:Diagnosis]]
			[[Category:Liver pathology]]

Michael: redirect

2012-12-19T13:23:27Z

redirect

New page

#redirect [[Liver pathology#Cholestasis]]