Intrahepatic cholestasis associated with an enlarged gall-bladder

Area of Science:

• Hepatology
• Gastroenterology
• Medical Imaging

Background:

• Painless jaundice with a palpable gallbladder often suggests extrahepatic biliary obstruction.
• Distinguishing the cause of cholestasis is crucial for appropriate patient management.

Observation:

• Two patients, one with a history of herbal medication use and another with malignant lymphoma, presented with painless jaundice and palpable gallbladders.
• Abdominal ultrasonography revealed enlarged gallbladders but normal-sized biliary trees without stones.

Findings:

• The diagnoses were drug-induced hepatitis with intrahepatic cholestasis and lymphomatous infiltration of the liver.
• These cases demonstrate that a palpable gallbladder in cholestatic jaundice does not exclusively indicate extrahepatic biliary obstruction.

Implications:

• Ultrasonography is a valuable tool for excluding extrahepatic biliary obstruction in cases of cholestatic jaundice with palpable gallbladders.
• This highlights the importance of considering non-obstructive causes like drug toxicity and malignancy in the differential diagnosis.