What is Post Hepatic Jaundice?
Post hepatic jaundice, also known as obstructive jaundice, occurs when there is an obstruction in the bile ducts that prevents bile from flowing from the liver to the small intestine. This leads to the accumulation of bilirubin in the blood, causing the characteristic yellowing of the skin and eyes.
Histological Features
In post hepatic jaundice, histological examination might reveal certain key features:- Cholestasis: This is the hallmark of obstructive jaundice and can be seen as the accumulation of bile within liver cells (hepatocytes) and bile ducts.
- Bile Duct Proliferation: There is often an increase in the number of bile ducts, which is a reactive process to the obstruction.
- Bile Plugs: These are seen within the bile canaliculi and ducts.
- Portal Tract Inflammation: There may be an inflammatory response in the portal tracts surrounding the bile ducts.
Causes
Post hepatic jaundice can be caused by several conditions that obstruct the bile ducts:- Gallstones: These can block the bile ducts.
- Tumors: Malignancies like cholangiocarcinoma or pancreatic cancer can compress or invade the bile ducts.
- Strictures: Scarring from previous surgeries or chronic inflammation can narrow the bile ducts.
- Parasites: In some regions, parasitic infections like liver flukes can block the ducts.
Histological Techniques Used for Diagnosis
Several histological techniques are employed to diagnose post hepatic jaundice:- Hematoxylin and Eosin (H&E) Staining: This is the most common staining technique used to observe general tissue architecture and identify abnormalities.
- Special Stains: Stains like Masson's Trichrome or Periodic Acid-Schiff (PAS) can be used to highlight fibrosis or mucin production.
- Immunohistochemistry: This technique is used to detect specific antigens in tissue sections, helping to identify the presence of tumors or other pathological processes.
Differences from Other Forms of Jaundice
Post hepatic jaundice must be distinguished from other types of jaundice, such as:- Pre-hepatic Jaundice: Caused by excessive breakdown of red blood cells, leading to increased production of bilirubin.
- Hepatic Jaundice: Results from liver diseases like hepatitis or cirrhosis where the liver cells are unable to process bilirubin properly.
Histologically, pre-hepatic jaundice would not show cholestasis, while hepatic jaundice would show liver cell damage and other features related to liver diseases.
Clinical Correlation
The histological findings in post hepatic jaundice correlate with clinical symptoms such as:- Yellowing of the Skin and Eyes: Due to the buildup of bilirubin.
- Dark Urine: Because of the excretion of conjugated bilirubin.
- Pale Stools: Resulting from the lack of bile in the intestines.
Identifying the underlying cause using imaging techniques like ultrasound or MRI, alongside histological examination, is crucial for effective treatment.
Treatment and Prognosis
The treatment of post hepatic jaundice focuses on relieving the obstruction. This can involve:- Endoscopic Procedures: Such as Endoscopic Retrograde Cholangiopancreatography (ERCP) to remove gallstones or place stents.
- Surgery: To remove tumors or repair strictures.
- Medications: To manage symptoms and underlying conditions.
The prognosis depends on the underlying cause and the timeliness of intervention. Early diagnosis and treatment typically lead to better outcomes.
