Sepsis in Liver

 Most often gram-negative infection

• Mechanisms uncertain but probably involve decreased activity and expression of canalicular and sinusoidal transporters

Clinical Issues

• Patients are systemically ill and typically jaundiced

• Enzyme elevations may be hepatocellular, cholestatic, or mixed


• Ductular cholestasis pattern strongly associated with sepsis
image Ductular reaction at perimeter of portal tracts with dilated profile, flattened epithelium, inspissated bile

• Variably present neutrophilic inflammation

• Canalicular cholestasis also common
image May lack significant attendant inflammation, especially in infants and children

Top Differential Diagnoses

• Large bile duct obstruction

• Total parenteral nutrition

Diagnostic Checklist

• Many entities in differential diagnosis can coexist along with sepsis and may confound histologic picture
image Blood cultures should be drawn in severely ill patients with these findings on biopsy

Ductular Dilatation and Inspissated Bile
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 image. The lobule shows reactive changes.

Ductular Cholestasis
This portal tract has ductular reaction at the periphery. The ductules contain dense, inspissated bile image (ductular cholestasis). Neutrophils may be variably present.

Inspissated Bile
This high-power view of a bile ductule illustrates the flattened, atrophic epithelium and dense, inspissated bile that are typical of ductular cholestasis.

Canalicular Cholestasis
Canalicular cholestasis image without significant accompanying inflammation, or “pure” cholestasis, is common in patients with sepsis/systemic infection, particularly infants and children.



• Spectrum of hepatic injury in patients with sepsis or bacteremia


Infectious Agents

• Systemic infection, usually gram-negative sepsis
image Most common underlying infectious processes

– Bacterial pneumonia

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Sepsis in Liver

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