Most often gram-negative infection
• Mechanisms uncertain but probably involve decreased activity and expression of canalicular and sinusoidal transporters
Diagnostic Checklist
A low-power photograph of a liver biopsy specimen in a septic patient shows expanded portal tracts with ductular reaction. Many of the ductules are dilated and contain inspissated bile
. The lobule shows reactive changes.
This portal tract has ductular reaction at the periphery. The ductules contain dense, inspissated bile
(ductular cholestasis). Neutrophils may be variably present.
This high-power view of a bile ductule illustrates the flattened, atrophic epithelium and dense, inspissated bile that are typical of ductular cholestasis.
without significant accompanying inflammation, or “pure” cholestasis, is common in patients with sepsis/systemic infection, particularly infants and children.ETIOLOGY/PATHOGENESIS
Infectious Agents
• Systemic infection, usually gram-negative sepsis
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