Cholestasis is the inhibition of bile secretion

1. Intrahepatic- cholestasis in the liver!
2. Extrahepatic- outside in the liver! In the bile ducts outside the liver. L and R hepatic ducts, common bile duct, etc.

** What enzyme is associated with cholestasis or bili obstruction? Alkaline phosphatase and GGTP. **

** What’s bile made up of? Bilirubin, water, electrolytes, cholesterol, phospholipids, bile salts, and lecithin. KNOW THIS! **

(a) Intrahepatic- cholestasis in the liver!

Causes of intrahepatic cholestasis:

• hepatocellular disease
• drugs
• estrogens
• pregnancy
• primary disease of the intrahepatic ductules

Example: intrahepatic ductile disease: primary biliary cirrhosis . we’ll talk about that later. Conjugated hyperbilirubinemia.

(b) Extrahepatic- outside the liver! In the bile ducts outside the liver.

Can occur in L and R hepatic ducts, common bile duct, etc. Most instances is due to obstruction. Gives rise to conjugated hyperbilirubinemia.

Causes:

• tumors
• stones
• any –itis (pancreatitis, cholangiitis)

** If you examine the stool with someone with this obstruction, what’ll the stool look like? It’ll be lighter than normal (like clay) and thus you have no urobilogen /urobilin… **

** If you examine the urine: is it dark or light? It’ll be darker than normal because the patient has conjugated hyperbilirubemia and it’s water-soluble and will end up in the urine. **

You’ll also have increases in other constituents like bile salts, and then you end up with bile salts in the blood and gives rise to itching.

** What are we talking about? Big broad category does jaundice fall under? Functional patterns of hepatic injury!

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