Intrahepatic Cholestatic Liver Disease

TITLE:	INTRAHEPATIC CHOLESTATIC LIVER DISEASE
AUTHOR:	DAVID S. BARNES, MD -- Department of Gastroenterology and Hepatology
PUBLISHED:	JULY 9, 2002

Table 1:
Causes of Cholestasis
Intrahepatic Cholestasis	Extrahepatic Biliary Tract Diseases
PBC (Primary Biliary Cirrhosis) PSC (Primary Sclerosing Cholangitis) Drugs and toxins Sepsis Malignancy Granulomatous liver disease Intrahepatic cholestasis of pregnancy Hepatitis (viral and alcoholic) Genetic disorders Graft versus host disease Post liver transplant	Choledocholithiasis Bile duct tumors (benign and malignant) Ampullary tumors (benign and malignant) Pancreatic carcinoma Mirizzi's syndrome AIDS cholangiopathy Parasites PSC (Primary Sclerosing Cholangitis) (see left)

Table 2:
Drug-induced Cholestasis
Cholestasis without Hepatitis	Cholestasis with Hepatitis	Cholestasis with Bile Duct Injury	Vanishing Bile Duct Syndrome	Sclerosing Cholangitis-like
Estrogens	Chlorpromazine	Dextropropoxyphene	Chlorpromazine	Floxuridine
Anabolic steroids	Macrolide antibiotics	Flucoxacillin	Flucloxacillin and other oxypenicillins	Intralesiond scolicidal agents (2% formaldehyde, 20% hypertonic saline, absolute alcohol, silver nitrate, iodine solution)
Cyclosporine	Tricyclic antidepressants	Carmustine	Amoxicillin-clavulanic acid
Tamoxifen	Carbamazepine	Toxins: paraquat, methylenedianiline	Ampicillin
Azathioprine	Amoxicillin-clavulanate		Amitriptyline
	Oxypenicillins		Azathioprine
	NSAIDs		Barbiturates
	Azathioprine		Carbamazepine
			Chlorthiazide
			Co-trimoxazole
			Clindamycin
			Chlorpromazine
			Cimetidine
			Cyproheptadine
			Dicloxacillin
			Erythromycin esters
			Estradiol
			Flucloxacillin
			Glycyrrhizin
			Haloperidol
			Ibuprofen
			Imipramine
			D-penicillamine
			Phenytoin
			Norandrostenolone
			Prochlorperazine
			Tetracycline
			Terbinafine
			Thiabendazole
			Tiopronin
			Tolbutamide
			Methyl testosterone

Table 3:
Causes of Hepatic Granulomatous Liver Disease
Infection	Chemicals	Miscellaneous	Drugs
Bacteria Brucellosis Tularemia Yersina Propioni Psuedomonas pseudomallei Spirochetal Treponema Rickettsia Q Fever Fungal Histoplasmosis Coccidiomycosis Blastomycosis Aspergillus Actinomycosis Nocardia Cryptococcus Candida Mycobacteria Tuberculosis Atypical mycobacteria Leprosy Parasites Ascaris Toxocara Schistosoma Leishmania Viruses Epstein-Barr Virus Cytomegalovirus HIV	Beryllium	Sarcoidosis Primary biliary cirrhosis Hodgkin's disease Non-Hodgkin's lymphoma Inflammatory bowel disease SLE Whipple's disease Wegener's granulomatosis Talc in drug abusers	Allopurinol Carbamazepine Chlorpropramide Hydralazine Methyldopa Nitrofurantoin Phenytoin Procainamide Quinidine Sulfonamides Sulfonylureas

Table 4:

Causes of Cholestasis After
Liver Transplantation

Infections (bacterial, CMV)
Medications
(immunosuppresive drugs, antibiotics)
Viral hepatitis B and C
Rejections (acute and chronic)
Recurrence of disease (PBC, PSC)

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