The Common Vein Copyright 2008

Definition

Cholestasis defined functionally as impaired flow of bile through the biliary tree.  This impaired flow causes an increase in bilirubin levels, which is conjugated to direct bilirubin, which at elevated serum levels causes marked pruritis.

Common causes of drug-induced cholestasis are: steroids, estrogens, even antipsychotic medications.

Diagnostic hallmarks are an increased alkaline phosphatase, and conjugated bilirubin levels.

Cholestatis as an entity is further characterized as being intrahepatic or extra hepatic.

Thin Sludge

11921.8b05b039.8s gallbladder distended enlarged dilated fluid fluid level gravity specific gravity sediment sludge cholestasis stasis Davidoff art copyright 2008

Tumefactive Bile

11921.8b05b043..8sb01 gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis Davidoff art copyright 2008

Sludge – Almost Fluid

78365c.8s gallbladder sludge cholestasis fluid fluid level USscan ultrasound Courtesy Ashley Davidoff MD copyright 2008

1004BH~1.8s.jpg

Sludge – Almost Fluid

1004BH~1.8s gallbladder cholestasis fluid fluid level free fluid ascites USscan Ultrasound CourtesyPhilips Medical Systems copyright 2008

Sludge – Almost Fluid Hyperdense

82010c01.8s gallbladder distended fluid fluid level sludge thickened bile cholestasis CTscan Courtesy Ashley DAvidoff MD copyright 2008

Sludge – and a Stone

04740.8s gallbladder cholestasis fluid fluid level cholelithiasis shadowing stone thickening of gallbladder fossa GBF USscan Ultrasound Courtesy Ashley Davidoff MD copyright 2008

Cholestasis – Fluid Stage

17087c.8s gallbladder cholestasis fluid fluid level gravity specific gravity dilated enlarged gallbladder sediment supernatant CBD stone MRI T1 weighted with gadolinium T2 weighted thick walled enhancing wall watery sludge Courtesy Ashley Davidoff MD copyright 2008

Acalculous Cholecystitis Crankcase Oil

11921.8b05b043.8s gallbladder distended tumefactive bile thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge cholestasis stasis inflammation acalculous cholecystitis Davidoff art copyright 2008

11921.8b05b043..8kb03.jpg

Wall Rupture

11921.8b05b043..8kb03 gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis wall inflammation acalculous cholecystitis complicated by perforation Davidoff art copyright 2008

Wall Rupture Focal Peritonitis

11921.8b05b043.8b05s gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis wall inflammation acalculous cholecystitis complicated by perforation Davidoff art copyright 2008

Rupture with Bile Peritonitis

11921.8b05b046.8b05 gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis wall inflammation acalculous cholecystitis complicated by perforation and bile peritonitis Davidoff art copyright 2008