Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

  • Rachana Amit Chaturvedi Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai
  • Jayashri Popat Chaudhari Seth G.S. Medical College and KEM Hospital, Mumbai
  • Mayura Kekan Seth.G.S.Medical College and K.E.M Hospital
  • Apurv Deshpande Seth.G.S.Medical College and K.E.M Hospital
  • Ramkrishna Prabhu Seth.G.S.Medical College and K.E.M Hospital
  • Amita Suresh Joshi Seth.G.S.Medical College and K.E.M Hospital
Keywords: obstructive jaundice, reversal, regression, liver fibrosis, histopathology


Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same.  Methods: Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1st bx) and postoperative (2nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation.Result: Patient’s age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice.  In 1st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis.Conclusion: We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same. DOI: 10.21276/APALM.1223

Author Biographies

Rachana Amit Chaturvedi, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai
Department of Pathology, Associate Professor
Jayashri Popat Chaudhari, Seth G.S. Medical College and KEM Hospital, Mumbai
Department of Pathology, Assistant Professor
Mayura Kekan, Seth.G.S.Medical College and K.E.M Hospital
Department of Pathology
Apurv Deshpande, Seth.G.S.Medical College and K.E.M Hospital
Department of Gasrointestinal surgery
Ramkrishna Prabhu, Seth.G.S.Medical College and K.E.M Hospital
Department of Gasrointestinal surgery
Amita Suresh Joshi, Seth.G.S.Medical College and K.E.M Hospital
Department of Pathology


1) Madhusudhan KS, Gamanagatti S, Srivastava DN, Gupta AK. Radiological interventions in malignant biliary obstruction. World Journal of Radiology2016; 8(5):518-529.
2) Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. 2000; 14(3):521-46.
3) Hastier P, Buckley JM, Peten EP, Dumas R, Delmont J. Long term treatment of biliary stricture due to chronic pancreatitis with a metallic stent. Am J Gastroenterol. 1999; 94(7):1947-8.
4) Deviere J, Cremer M, Baize M, Love J, Sugai B, Vandermeeren A. Management of common bile duct stricture caused by chronic pancreatitis with metal mesh self-expandable stents. Gut Jan1994; 35(1):122-6.
5) Kamisawa T, Tu Y, Egawa N, Nakajima H, Tsuruta K, Okamoto A. Involvement of pancreatic and bile ducts in autoimmune pancreatitis. World J Gastroenterol. Jan 28 2006; 12(4):612-4.
6) Magistrelli P, Masetti R, Coppola R, Coco C, Antinori A, Nuzzo G et al. Changing attitudes in the palliation of proximal malignant biliary obstruction. J SurgOncol. Suppl1993; 3:151-3.
7) Portmann BC, NakanumaY. Diseases of the bile ducts. In: MacSweenRNM, Burt AD, Portmann BC, Ishak KG, Scheuer PJ, Anthony P. Peds. Pathology of the Liver, 4th ed. London, England, Churchill Livingstone, 2002;435-506.
8) PellegriniCA, Thomas MJ, Way LW. Recurrent biliary stricture: patterns of recurrence and outcome of surgical therapy. Am J Surg. 1984;147175-180.
9) Sikora SS, Shrikanth G, Agrawal V, Gupta RK, Kumar A, Saxena R et al. Liver histology in benign biliary stricture: fibrosis to cirrhosis and reversal? J GastroenterolHepatol. 2008;23: 1879-1884.
10) Kirkland JG, Godfrey CB, Garrett R, Kakar S, Yeh BM, Corvera CU. Reversible surgical model of biliary inflammation and obstructive jaundice in mice. J Surg Res. 2009; 164(2):221-7.
11) Franco D, Gigou M, Szekely AM, Bismuth H. Portal hypertension after bile duct obstruction: effect of bile diversion on portal pressure in the rat. Arch Surg. 1979;114:1064-7.
12) Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S. Results of Surgical Resection for Patients With HilarBile Duct Cancer:Application of Extended Hepatectomy After Biliary Drainage and Hemihepatic Portal Vein Embolization. Annals of Surgery2003;238(1):84-92.
13) Hammel P, Couvelard A, O’Tootle D, Ratouis A, Sauvanet A, Flejou JF et al. Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of common bile duct. New Engl. J. Med. 2001;344: 418–23.
14) Chalya Philipo L, Kanumba ES, Mchembe M. Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges BMC Research Notes 2011;4:147.
15) Verma S, Sahai S, Gupta P, Munshi A, Verma S, Goyal P. Obstructive Jaundice- Aetiological Spectrum, Clinical, Biochemical And Radiological Evaluation At A Tertiary Care Teaching Hospital.The Internet Journal of Tropical Medicine 2010;7(2).
16) Pitiakoudis M, Mimidis K, Tsaroucha AK, Papadopoulos V, Karaviannakis A, Simopoulos C. Predictive value of risk factors in patients with obstructive jaundice. J Int Med Res.2004;32:633-8.
17) Negi SS, Sakhuja P, Malhotra V, Chaudhary A. Factors Predicting Advanced Hepatic Fibrosis in Patients With Postcholecystectomy Bile Duct Strictures. Arch Surg. 2004; 139(3):299-303.
18) Aronson DC, De Haan J, James J et al.Quantitative aspects of the parenchyma-stroma relationship in experimentally induced cholestasis. Liver 1988; 8: 116-126.
19) Rothlin MA, Loppe M, Schlumpf R, Largiader F. Long_term results of hepaticojejunostomy for benign lesion of bile ducts. Am J Surg. 1998; 175:22-26
20) Scobie BA, Summerskill WHJ. Hepatic cirrhosis secondary to obstruction of the biliary system. American Journal of Digestive Diseases. 1965; 10:135-146.
21) Zimmerman H, Reichen J, Zimmerman A, Sägesser H, Thenisch B, Höflin F. Reversibility of secondary biliary fibrosis by biliodigestive anastomosis in the rat. Gastroenterology 1992; 103:579-89.
Original Article