MRP2/ABCC2
INTRA-HEPATIC
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EXTRA-HEPATIC
INFECTIONS
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HEPATOCYTES
INFLAMMATION:
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? Viral hepatitisAutoimmune
? Alcoholic hepatitis
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DRUG INDUCED
? Drug induced
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? SepsisCentrilobular
CONGENITAL/INHERITED
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? Progressive familial
INTRAHEPATIC
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BILE DUCTS? Primary Biliary
intrahepatic
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causes
Periportal
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cirrhosischolestasis
? Primary sclerosing
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? Benign recurrent
cholangitis
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cholestasis? Vanishing bile duct
syndrome
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INFILTRATION
? Amyloidosis
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? Tuberculosis? Lymphoma
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INSIDE THE LUMEN
IN THE WALL
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PRESSURE FROM OUTSIDE
NORMAL HISTOLOGY
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GENERAL CHOLESTASIS FEATURES
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FEATHERY DEGENERATIONRobbins Pathological Basis of Disease, 9th edition
GENERAL CHOLESTASIS FEATURES
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Robbins Pathological Basis of Disease, 9th edition
AUTOIMMUNE
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CHOLANGIOPATHIES
Robbins Pathological Basis of Disease, 9th edition
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PRIMARY BILIARY CIRRHOSIS? SMALL & MEDIUM SIZE DUCTS
? NON-SUPPURATIVE
? EXTRA HEPATIC BILIARY TREE NOT
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INVOLVED
? PATCHY INVOLVEMENT
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" FLORID DUCT LESION"Robbins Pathological Basis of Disease, 9th edition
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PRIMARY SCLEROSING CHOLANGITIS
? BOTH INTRA & EXTRA HEPATIC DUCTS
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? INFLAMMTION & SCLEROSIS? INTERMITTENT SEGMENTS DILATED
? ULCERATIVE COLITIS
"ONION SKIN" FIBROSIS
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NORMAL
MR CHOLANGIOGRAM: "BEADING"
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Robbins Pathological Basis of Disease, 9th editionBILE DUCT SCAR FORMATION
"ONION SKIN" FIBROSIS
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SPOT THE DIFFERENCES
BILIARY CIRRHOSIS
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SPECIAL CASE IN NEONATES
NEONATAL
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EXTRA HEPATIC
HEPATITIS
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BILIARY ATRESIANOT A SINGLE DISEASE
OBSTRUCTIVE CAUSE
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NOT NECESSARILY INFLAMMATORY
INFLAMMATION & FIBROSIS
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TOXIC, METABOLIC, INFECTIOUS,IDIOPATHIC
SURGICAL TREATMENT: KASAI
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NON- OBSTRUCTIVE
VERY IMPORTANT TO DIFFERENTIATE THE
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TWO!NEONATAL HEPATITIS
EHBA
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EHBA
Robbins Pathological Basis of Disease, 9th edition
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AMYLOIDOSIS
Summary
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? Causes? Intra: Hepatocytes, Bile ducts, Portal tract
? Extra: Benign, Malignant
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? NEONATES
? Neonatal Hepatitis
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? EHBA? Early phases: Reversible
? Late stages: Biliary cirrhosis Irreversible
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