Sepsis in the Liver
Laura Webb Lamps, MD
Key Facts
Terminology
Spectrum of hepatic injury in patients with sepsis or bacteremia
Etiology/Pathogenesis
Usually caused by sepsis from underlying bacterial pneumonia or intraabdominal infection
Clinical Issues
Patients are systemically ill from sepsis/bacteremia
Jaundice is common
Enzyme elevations may be hepatitic, cholestatic, or mixed
Microscopic Pathology
Ductular cholestasis pattern strongly associated with sepsis
Proliferated bile ductules at perimeter of portal tracts with inspissated bile
Neutrophilic inflammation also common
 Hematoxylin & eosin shows proliferated bile ductules at the periphery of the portal tract that contain dense, inspissated bile  (ductular cholestasis). |
 Hematoxylin & eosin shows canalicular cholestasis  without significant accompanying inflammation. “Pure” cholestasis is common in infants and children. |
TERMINOLOGY
Definitions
Spectrum of hepatic injury in patients with sepsis or bacteremia
ETIOLOGY/PATHOGENESIS
Infectious Agents
Systemic infection, usually bacterial
Most common underlying infectious processes
Bacterial pneumonia
Intraabdominal suppurative infection
Mechanism uncertain
Presumably, bacterial endotoxins interfere with normal ductular secretory activity and resorption
