Analysis of Morphological Changes in Liver in Obstructive Jaundice with Special Emphasis on Fibrosis

Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same. Methods: Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1st bx) and postoperative (2nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation. Result: Patient’s age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice. In 1st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/ static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis. Conclusion: We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same.