Intrahepatic Cholestasis Associated with Alcoholic Liver Disease

 

Clinical features:

(1) right upper quadrant pain and tenderness

(2) jaundice

(3) hepatomegaly

(4) recent excessive alcohol use (may be denied)

 

Laboratory features:

(1) elevated serum alkaline phosphatase

(2) elevated serum total bilirubin

 

Imaging findings:

(1) negative ultrasound for stones and obstruction

(2) negative ERCP

(3) negative transhepatic cholangiography

 

Liver biopsy findings:

(1) alcoholic steatohepatitis or cirrhosis

(2) bile plugs in canaliculi

(3) variable cholangitis

(4) negative for findings of large duct obstruction

 

Problems in diagnosis may occur if the patient also has:

(1) cholelithiasis OR

(2) pancreatitis

 

Differential diagnosis:

(1) viral hepatitis

(2) cholestatic drug reaction

(3) non-alcoholic steatohepatitis