What are the intrahepatic causes of biliary obstruction?

Updated: Oct 16, 2019
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Answer

Mechanical or intrahepatic causes are most commonly hepatitis and cirrhosis. Drugs may also cause direct damage to hepatocytes and metabolic obstruction. Note the following:

  • Hepatitis is inflammation of the liver characterized by diffuse or patchy necrosis. Causes of hepatitis include viruses, drugs, and alcohol.

  • Cirrhosis is characterized by generalized disorganization of hepatic architecture with nodule formation and scarring in the parenchyma. Cirrhosis results from chronic, not acute, inflammation of the liver. Although many causes exist, the majority of cases of cirrhosis in the United States are sequelae of alcoholic hepatitis or chronic hepatitis B and C infections. Primary biliary cirrhosis (PBC) is a chronic, progressive, nonsuppurative, granulomatous destruction of the intrahepatic ducts. PBC, an autoimmune destruction of small hepatic ducts, is more common in women than in men.

  • Drugs, such as anabolic steroids and chlorpromazine, are known to directly cause cholestasis (by mechanisms not entirely understood). Thiazide diuretic use may slightly increase the risk for developing gallstones, the most common cause of biliary obstruction. Amoxicillin/clavulanic acid (Augmentin) is one of the most frequent causes of acute cholestatic injury that can mimic biliary obstruction. Other drugs, such as acetaminophen or isoniazid, can cause hepatocellular necrosis. Typically, drug-induced jaundice appears early with associated pruritus, but the patient's well-being shows little alteration. Generally, symptoms subside promptly when the offending drug is removed.

  • Liver space occupying lesions (SOLs) e.g. cysts (including hydatid), abscesses, tumors (including metastases and primary)


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