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September 1979

Intrahepatic Cholestasis

Arch Intern Med. 1979;139(9):1038-1045. doi:10.1001/archinte.1979.03630460070021

Cholestasis is defined as blockaded or suppressed secretion of bile.1 The physiologist, morphologist, clinical biochemist, and clinician each view the phenomenon through a different prism.2-6 The biliary physiologist focuses on the factors responsible for measurable reductions in bile flow and draws conclusions regarding normal bile production from these observations.4-6 The morphologist views cholestasis as the presence of bilirubin casts in distended canaliculi and of associated degenerative changes in the hepatocytes ("feathery necrosis," "pseudoxanthomatous degeneration") attributable to retained bile acids.3.4.7 The clinical biochemist regards cholestasis as the accumulation in the blood of components of bile.3.6 The clinician considers cholestasis to mean jaundice due to anatomical blockade of the common bile or hepatic duct (extrahepatic cholestasis, more often called obstructive or posthepatic jaundice) or due to hepatic disease leading to impaired secretion or flow of bile (intrahepatic cholestasis).8 Indeed, most clinicians consider cholestatic jaundice to mean

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