TABLE 5-1

BILE DUCT INJURY AND LOSS

	Characteristic Duct Features	Loss of Ducts	Large Duct Involvement	Development of Cirrhosis
Acute Cholangitis	Epithelial damage with neutrophil infiltration	No	Yes (with biliary obstruction)	Infrequent
Primary Biliary Cirrhosis	Florid duct lesion (+/- granulomas)	Yes	No	Yes
Primary Sclerosing Cholangitis	Obliterative periductal fibrosis	Yes	Yes	Yes
Hepatitis (acute and chronic)	Epithelial damage with lymphocyte infiltration	No	No	Yes (with chronic hepatitis)
Drug-related	Variable	Uncommon	No	Uncommon
Sarcoidosis	Granulomatous damage	Uncommon	No	Uncommon
Allograft Rejection	Epithelial damage with inflammatory infiltration	Yes (with chronic rejection)	No	Uncommon
Graft-vs-Host Disease	Epithelial damage with inflammatory infiltration	Yes	No	Uncommon

TABLE 5-2

STAGING OF PRIMARY BILIARY CIRRHOSIS

	Scheuer98	Ludwig, et al98
Stage 1	Florid Duct Lesion bile duct damage portal inflammation	Portal Stage portal inflammation
Stage 2	Ductular Proliferation expanded portal tracts proliferated bile ductules piecemeal necrosis	Periportal Stage periportal inflammation +/- piecemeal necrosis
Stage 3	Scarring fibrosis loss of bile ducts	Septal Stage fibrous septa bridging necrosis
Stage 4	Nodular Cirrhosis	Cirrhosis

TABLE 5-3

STAGING OF PRIMARY SCLEROSING CHOLANGITIS

Stage 1	Portal Stage portal inflammation or bile duct abnormalities
Stage 2	Periportal Stage periportal fibrosis or prominent enlargement of portal tract
Stage 3	Septal Stage fibrous septa bridging necrosis
Stage 4	Cirrhotic Stage

modified from reference 152