Intrahepatic cholestasis

Introduction Cholestatic hepatitis is a special clinical type characterized by intrahepatic cholestatic, also known as capillary hepatitis. It is a disorder of capillary bile duct excretion caused by various reasons. Bile can not actively discharge through the bile duct to the intestine but return to a blood in the blood. It is characterized by long-term refractory jaundice (usually 2 to 6 months), itchy skin, light stool color and hepatomegaly. Common cases are viral cholestatic hepatitis. Drug-induced cholestatic hepatitis and primary biliary cirrhosis. Viral cholestatic hepatitis accounts for about 3% of patients with viral hepatitis. It can be caused by hepatitis A, B, and E. It occurs more than a few weeks after the onset of acute hepatitis.

Cause

It is a disorder of capillary bile duct excretion caused by various reasons. Bile can not actively discharge through the bile duct to the intestine but return to a blood in the blood. It often occurs several weeks after the onset of acute hepatitis. Cholestatic jaundice is common in autoimmune hepatitis (cholecystosis), primary biliary cirrhosis, primary sclerosing cholangitis, drug-induced hepatitis, and viral cholestatic hepatitis.

an examination

Related inspection

MRI examination of liver, gallbladder, pancreas and spleen by liver, gallbladder and spleen

Blood test

Serum bilirubin is significantly elevated, mainly direct bilirubin. R-glutamyl transpeptidase, alkaline phosphatase, cholesterol and serum bile acids were elevated. At the beginning of the disease, ALT increased significantly, but it decreased rapidly, and enzyme separation occurred.

Some patients had decreased prothrombin activity when they were admitted to the hospital, but they were quickly corrected after 3 to 7 days of supplementation with vitamin K1.

2.B-ultrasound

No extrahepatic obstruction.

3. Pathological examination

The microbiliary tube is cholestatic and the bile duct hyperplasia is obvious. Under the electron microscope, the capillary bile duct is dilated, the bile duct is formed in the capillary bile duct, and the microvilli have lesions, and the hepatocyte necrosis is not prominent.

Differential diagnosis

Classification of intrahepatic obstructive yellow disease

1, intrahepatic cholestatic

1 capillary cholangitis viral hepatitis;

2 drug jaundice;

3 idiopathic jaundice during pregnancy;

4 alcoholic liver syndrome;

5 jaundice after benign surgery;

5 idiopathic benign recurrent intrahepatic cholestatic;

1 primary biliary cirrhosis.

2, intrahepatic mechanical obstruction

1 primary sclerosing cholangitis;

2 intrahepatic bile duct stones;

3 Huazhi haemorrhagic disease;

4 Blue Giardia protozoa cholangitis;

5 obstructive jaundice type liver cancer.

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