Pathogenesis of So-called Intrahepatic Cholestasis Based on Three-dimensional Analysis of the Cholangiolar System

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Abstract
Liver specimens from 3 cases of the so-called intrahepatic cholestasis were submitted to graphic reconstructions of the cholangiolar system by means of serial histological sections and were examined for obstructive changes of the system. The results were evaluated in comparison with those obtained with a normal liver. Although routine histological examinations failed to demonstrate any significant change of the bile duct, the 3-dimensional analysis revealed a striking disturbance in the continuity of biliary pathways. Remarkable structural derangements of the cholangiolar system were found in all the examined cases. This was interpreted as a result of disseminated cholangiolar lesions followed by regeneration of bile ductules, which was, however, unsuccessful to restore sufficient passage to bile flow. The same pattern of cholangiolar derangement was also demonstrated in cases of subacute serum hepatitis. This indicated that viral hepatitis was commonly accompanied by a cholestatic mechanism, which was exaggerated in intrahepatic cholestasis. The so-called intrahepatic cholestasis, characterized by jaundice of obstructive character and by absence of other serious functional impairment of the liver, was regarded as a sequela of hepatitis, most frequently of viral origin, when the cholangiolar derangement persisted long after recovery of liver cell injuries. Consequently, it was not acknowledged as an independent pathological entity, and "cholangiolar derangement syndrome was proposed to designate the condition.