Biliary Secretory Failure in Man

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Abstract
Intrahepatic cholestasis is failure of the liver to secrete bile. The syndrome has a common hepatic histological, clinical and biochemical background on which is imposed the characteristics of the various causative conditions. The syndrome occurs at all levels in the liver cell and intrahepatic bile duct system and is of various types. The genetic group includes the Dubin-Johnson type of conjugated hyperbilirubinemia. Drugs such as norethandrolone or methyl testosterone cause a canalicular type of cholestasis and the relationship of this to the use of contraceptive drugs is discussed. The idiopathic jaundice of the last trimester of pregnancy seems to be of similar type. Patients who have a predisposition to this condition and who take contraceptive pills are liable to become jaundiced. Other drugs cause cholestasis as part of a sensitivity reaction and these include the promazines. Idiopathic recurrent cholestasis may be of similar type. Predominantly hepatocellular diseases such as virus hepatitis, postnecrotic cirrhosis, or alcoholic hepatitis may go through a prolonged cholestatic phase and so cause great difficulty in diagnosis from obstruction to major bile ducts. The cholestasis may be at a ductal or ductular level. Primary biliary cirrhosis is the best example of this. Others at this level include sclerosing cholangitis primary or secondary to obstruction of large bile ducts and some of the congenital biliary atresias.
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