Bile ducts, intrahepatic

Dibutyltin dichloride induced acute pancreatitis and bile duct lesions in rats, depending on dose (6 and 8 mg/kg body weight intravenously) and time (1-24 weeks) (Merkord Hennighausen, 1989 Merkord et al., 1997, 1999 Sparmann et al., 2001). The lesions in the pancreas developed into a pancreatic fibrosis, and the lesions in the liver into liver cirrhosis. A single intravenous administration of dibutyltin dichloride at 4 mg/kg body weight induced a mild interstitial pancreatitis after 2 days (Merkord et al., 2001). Repeated administration of dibutyltin dichloride (4 mg/kg body weight intravenously) to rats at intervals of 3 weeks induced acute interstitial pancreatitis and, after 9-12 weeks, a pancreatic fibrosis and liver lesions (intrahepatic bile duct hyperplasia) (Merkord et al, 2001). 

Primary biliary cirrhosis is characterized by progressive inflammatory destruction of the bile ducts. Immune-mediated inflammation of intrahepatic bile ducts results in remodeling and scarring, causing retention of bile within the liver and subsequent hepatocellular damage and cirrhosis. The number of patients affected with primary biliary cirrhosis is difficult to estimate because many people are asymptomatic and incidental diagnosis during routine health care visits is common. 

Melanoma of the skin Liver intrahepatic bile duct Leukemia... 

Leukemia Kidney renal pelvis Liver intrahepatic bile duct... 

Canaliculi enter canals of Hering in the portal triad and lead to intrahepatic bile ducts which coalesce to form the hepatic bile duct. The bile duct empties the bile into the gaU bladder which then is released into the duodenum. Bile that is excreted into the small intestine enhances nutrient uptake, protects enterocytes from oxidation, and facilitates excretion of xenobiotics and endogenous waste in the feces (Treinen-Moslen, 2001). 

ERASISTRATUS OF KEOS (ca. 300-250 BC) Coined the term "parenchyma (i.e. poured out beside) for liver tissue, based on the belief that it was formed by coagulation of the blood released from the hepatic vessels. For him, however, liver parenchyma was a completely useless structure. He also described for the first time the "choledochos , which he believed absorbed the redundant and rather harmful bile (transported into the liver with the portal vein blood) from the intrahepatic bile ducts, and conducted it away. This separation of bile from blood in the liver was allegedly effected by the different viscosities of the two fluids and the different diameters of the adjacent ( ) intrahepatic bile ducts and blood vessels. Stoppage of the bile flow would lead to jaundice (obstructive icterus ) and inflammation of the liver. He attributed the dropsy commonly associated with liver disease to a hardening of the liver, which he termed "skirros this compressed the intrahepatic vessels, diverting the flow of the watery fluid into the abdomen. Based on this surmise, he rejected the practice of... 

Fig. 6.9 Blockage and dilation of the intrahepatic bile ducts ( lakeland plain ) in obstructive jaundice...

Obstruction of a large bile duct leads to dilated intrahepatic bile ducts, which appear on CT scans as ramified linear or rounded structures with bile-equivalent density. Their luminal diameter increases progressively in the direction of the hilus. (47) Segmental dilation of the bile ducts may be indicative of a tumour. A dilation of the bile duct of >9 mm points to a peripheral obstruction, mostly near the papilla of Vater. 

Suspected congenital intrahepatic bile-duct cysts (Caroli s disease)... 

Fig. 8.14 Use of ERC in obstructive jaundice induced by a large biliary concrement, with congested extra- and intrahepatic bile ducts. Secondary findings shrunken gall bladder with a chole-cystocholic fistula...

Teefey, S., Baron, R.L., Schulte, S.J., Patten, R.M., Molloy, M.H. Patterns of intrahepatic bile duct dilatation at CT correlation with obstructive disease processes. Radiology 1992 182 139—142... 

Teplick, St.K., Flick, P., Brandon, J.C. Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts. Gastrointest. Radiol. 1991 16 193-197... 

This form of jaundice is initiated by a mechanical obstruction in the region of the extrahepatic or intrahepatic bile ducts, which is why the terms mechanical jaundice or obstructive jaundice are also common. The congestion of the bile flow is either incomplete or complete. Bile stasis results in dilation of the extrahepatic and intrahepatic bile ducts, allowing hepatomegaly to develop. (8, 9, 16, 19) (s. tab. 12.1)... 

Intrahepatic obstructive jaundice relates to the intrahepatic bile ducts, which can be blocked, above all mech-... 

This form of cholestasis is derived from a temporary or permanent obstruction of the intrahepatic bile ducts. Diffuse processes of disease can act as mechanical obstacles in the hepatic parenchyma, or major bile ducts may be subject to regional obstruction, (s. tab. 13.3)... 

Localization Gall bladder Dilation Choledochal duct Intrahepatic bile ducts... 

Finegold, M.J., Carpenter, R.J. Obhterative cholangitis due to cytomegalovirus A possible precursor of paucity of intrahepatic bile ducts. Hum. Path. 1982 13 662-665... 

During cholecystectomy, choledocholithiasis was found in 12-24%o of cases. A stone-free gall bladder does not exclude cholangiolithiasis. About 80% of the bile-duct stones are found in the choledochus, 15% in the common hepatic duct and 5% in the intrahepatic bile ducts. In obstructive cholangitis, the recognition and removal... 

However, the intrahepatic bile-duct system is indeed still immature at birth, so that the final development of the smallest ramifications takes place during the first few neonatal weeks. At this stage, the intrahepatic biliary system is therefore very susceptible to noxae, which can lead to paucity or even atresia of the bile ducts. 

Virus infections Viral cholangiopathy, sometimes with concomitant destruction of the intrahepatic bile ducts, has been reported to derive from several species of viruses, e.g. HIV, cytomegaly, rotaviruses, respiratory syncitial virus (RS), hepatitis C, congenital rubella and reovirus 1 Bacteria may, however, also be the cause of disease, as is the case with congenital syphilis. 

Desmet, V.J. Congenital diseases of intrahepatic bile ducts variations on the theme ductal plate malformation . Hepatology 1992 16 1069-1083... 

Woolf, GJM., Vierllng, JJM. Disappearing intrahepatic bile ducts the syndromes and their mechanisms. Semin. Liver Dis. 1993 13 261 —275... 

Bile-duct papillomatosis Biliary hamartoma Caroli s disease/syndrome Intrahepatic bile-duct adenoma Intrahepatic bile-duct cystadenoma... 

Four types of cysts can be differentiated (i.) dysontogenetic cysts, (2.) parasitic (or infectious) cysts, (i.) neoplastic cysts and (4.) post-traumatic cysts. The cause of cystic neoplasms is unknown. Traumatic cysts (C. Whipple, 1898) occur from an injured intrahepatic bile duct after blunt abdominal trauma. (136)... 

Fig. 36.13 ERC findings in Caroli s disease mainly segmental, sack-like dilatations of the intrahepatic bile ducts with some small-diameter connections to the efferent bile ducts...

Haemangiomatosis Haematoma Haemochromatosis Intrahepatic bile-duct calculus... 

Sonography In this biochemical constellation, sonography (also colour-encoded duplex sonography with visualization of the intrahepatic bile ducts) is the examination technique of choice, particularly when obstructive jaundice is suspected. There is evidence of prestenotically dilated bile ducts as well as, in some cases, accompanying strand-like, hyperechoic, infiltrating structures, which may be surrounded by a hypo-echoic margin. The tumour itself can be identified in most cases, particularly when it is localized in the liver hilum. 

In 27 patients who received intrahepatic floxuridine, total dose 20-41 mg/kg extrahepatic biliary sclerosis was discovered by CT scan and ultrasound, followed by endoscopic retrograde cholangiopancreatography and/or percutaneous cholangiography in three cases (4). Radiological findings included complete obstruction of the common hepatic duct in one case, common hepatic duct stenosis in two cases, common bile duct obstruction in one case, and intrahepatic bile duct dilatation without identifiable obstruction in one case... 

Biliary atresia is a heterogeneous group of acquired disorders that involve either the extrahepatic or intrahepatic bile ducts. Possible etiologies include cytomegalovirus, reovirus III, Epstein-Barr virus, rubella virus, tti-antitrypsin deficiency, Down syndrome, and trisomy 17 or 18. 

Intrahepatic biliary atresia is characterized by a paucity of intrahepatic bile ducts. Jaundice usually appears within the first few days of life. Serum bilirubin is elevated and serum cholesterol may be very high and lead to the formation of xanthomas. The hepatic histology is nonspecific, showing bile duct paucity, giant cells, inflammation, and fibrosis. Survival into adolescence is common, although growth is usually retarded. 

Criteria for the diagnosis of AIH have been developed by an international group and have been revised to improve their use. The criteria include (1) exclusion of other causes of liver injury (2) elevation of aminotransferases with minimal increase in ALP (3) presence of elevated immunoglobulins positive ANA, ASMA, or anti-LKMi, with negative antimitochondrial antibody (4) compatible histological features and (5) absence of intrahepatic bile duct injury. A scoring system based on these criteria has also... 

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