Posthepatisch

Posthepatisch, a term used in hepatology and German medical language, literally means after the liver. It describes conditions or findings related to bile flow that are distal to the hepatic ducts, i.e., obstruction or disease of the biliary tree beneath the liver hilum. In medical practice it is contrasted with prehepatisch (before the liver) and hepatic (within the liver). Clinically, posthepatic jaundice presents with conjugated hyperbilirubinemia, cholestasis, dark urine, pale stools, pruritus, and sometimes abdominal pain. Laboratory findings typically show elevated alkaline phosphatase and gamma-glutamyl transferase, with increased direct bilirubin; transaminases may be modestly elevated.

Common causes include choledocholithiasis (stones in the common bile duct), benign or malignant biliary strictures, pancreatic or periampullary tumors compressing the distal common bile duct, post-surgical biliary obstruction, and biliary atresia in neonates. Less frequent etiologies include parasitic or inflammatory strictures.

Diagnostic workup starts with ultrasound to detect ductal dilation and stones, followed by MRCP for noninvasive visualization of the biliary tree. ERCP or intraoperative cholangiography may be used for diagnosis and therapeutic intervention (stone extraction, stent placement, dilation of strictures). Management focuses on relieving obstruction and treating complications such as cholangitis; this may involve endoscopic or surgical procedures, drainage, and addressing the underlying cause.

Prognosis depends on the underlying cause and timely relief of obstruction; untreated posthepatic obstruction can lead to cholangitis, liver dysfunction, and secondary biliary cirrhosis.