TAILIEUCHUNG - Chapter 043. Jaundice (Part 8)

Drugs may cause intrahepatic cholestasis, a variant of drug-induced hepatitis. Drug-induced cholestasis is usually reversible after eliminating the offending drug, although it may take many months for cholestasis to resolve. Drugs most commonly associated with cholestasis are the anabolic and contraceptive steroids. Cholestatic hepatitis has been reported with chlorpromazine, imipramine, tolbutamide, sulindac, cimetidine, and erythromycin estolate. It also occurs in patients taking trimethoprim, sulfamethoxazole, and penicillin-based antibiotics such as ampicillin, dicloxacillin, and clavulinic acid. Rarely, cholestasis may be chronic and associated with progressive fibrosis despite early discontinuation of the drug. Chronic cholestasis has been associated with chlorpromazine and prochlorperazine. . | Chapter 043. Jaundice Part 8 Drugs may cause intrahepatic cholestasis a variant of drug-induced hepatitis. Drug-induced cholestasis is usually reversible after eliminating the offending drug although it may take many months for cholestasis to resolve. Drugs most commonly associated with cholestasis are the anabolic and contraceptive steroids. Cholestatic hepatitis has been reported with chlorpromazine imipramine tolbutamide sulindac cimetidine and erythromycin estolate. It also occurs in patients taking trimethoprim sulfamethoxazole and penicillin-based antibiotics such as ampicillin dicloxacillin and clavulinic acid. Rarely cholestasis may be chronic and associated with progressive fibrosis despite early discontinuation of the drug. Chronic cholestasis has been associated with chlorpromazine and prochlorperazine. Primary biliary cirrhosis is an autoimmune disease predominantly of middle-aged women in which there is a progressive destruction of interlobular bile ducts. The diagnosis is made by the presence of the antimitochondrial antibody that is found in 95 of patients. Primary sclerosing cholangitis is characterized by the destruction and fibrosis of larger bile ducts. The disease may involve only the intrahepatic ducts and present as intrahepatic cholestasis. However in 95 of patients with PSC both intra- and extrahepatic ducts are involved. The diagnosis of PSC is made by imaging the biliary tree. The pathognomonic findings are multiple strictures of bile ducts with dilatations proximal to the strictures. Approximately 75 of patients with PSC have inflammatory bowel disease. The vanishing bile duct syndrome and adult bile ductopenia are rare conditions in which there are a decreased number of bile ducts seen in liver biopsy specimens. The histologic picture is similar to that found in primary biliary cirrhosis. This picture is seen in patients who develop chronic rejection after liver transplantation and in those who develop graft-versus-host disease after .

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