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Posthepatische

Posthepatic, in medical usage, describes conditions in which bile flow is obstructed after it leaves the liver. The term is often used to denote obstructive jaundice caused by blockage of the biliary tract, most commonly in the extrahepatic ducts (such as the common bile duct) or at the level of the ampulla, though large intrahepatic ducts can also be involved. It is contrasted with prehepatic jaundice, due to increased production of bilirubin from hemolysis, and hepatic jaundice, due to liver parenchymal disease.

Pathophysiologically, posthepatic obstruction prevents the excretion of conjugated bilirubin into the intestine. This leads to conjugated

Common causes include gallstone disease with choledocholithiasis, biliary strictures (benign or malignant, including postoperative strictures), pancreatic

Diagnosis starts with liver function tests showing cholestatic patterns, followed by imaging. Ultrasound is typically first-line,

(direct)
hyperbilirubinemia,
with
bilirubin
appearing
in
the
serum.
Clinically,
patients
often
develop
dark
urine
(due
to
bilirubin
excretion
in
urine),
pale
or
clay-colored
stools
(reduced
biliary
pigments
in
the
gut),
and
jaundice.
Pruritus
can
occur,
and
signs
of
cholestasis
such
as
elevated
alkaline
phosphatase
(ALP)
and
gamma-glutamyl
transferase
(GGT)
are
common.
head
tumors,
cholangiocarcinoma,
and
other
conditions
that
obstruct
the
biliary
tree.
The
presentation
can
be
painless
or
accompanied
by
abdominal
pain,
depending
on
the
cause
and
level
of
obstruction.
with
magnetic
resonance
cholangiopancreatography
(MRCP)
or
endoscopic
retrograde
cholangiopancreatography
(ERCP)
used
for
confirmation
and
treatment.
Management
focuses
on
relieving
the
obstruction
(eg,
stone
extraction,
stenting,
dilation,
or
surgical
bypass)
and
addressing
the
underlying
cause.
Prognosis
depends
on
the
etiology
and
timeliness
of
intervention.