Definition

• Liver not producing or releasing bile normally
• Histological:
  • Biliary obstruction (e.g. Gallstone Diseases) (↑ALP, ↑GGT)
  • Microscopic duct destruction (↑ALP, ↑GGT)
  • Impaired bile canaliculi transportation (↑ALP)
• Biochemical: more significant elevation in
  • ALP (< 120)
  • GGT (< 50)

DDx and Test Pattern

Obstructive: problem with bile flow

• Macroscopic/Extrahepatic: can be detected on imaging (biliary duct dilatation)

  • Painful → stone
  • Painless → strictures, benign obstruction (e.g. IgG4), malignant obstruction (cancer)

  Location of blockage	Condition	Test (in addition to ‣ )
  Duct wall	‣, ‣	‣, ‣ and ‣
  Duct lumen	Other Gallstone Diseases (e.g. ‣)	US of GB, ‣
  Extrinsic	‣	‣

• Microscopic/Intrahepatic: cannot be detected on imaging

  Condition	Test (in addition to US)
  ‣	‣ + 6 mon elevation of ALP (< 120) , IgM

• Metabolic: problem with bile production

  Condition	Test (in addition to US)
  ‣	History, ‣
  ‣ : Intrahepatic cholestasis of pregnancy	History, ‣

• Decision process

Mixed Pattern Liver Disease