Acute Large Bile Duct Obstruction with Acute, Ascending Cholangitis

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Needle biopsy.
This 23 year old man came in to the clinic with very vague symptoms, no referable history and mild fever. His serum liver tests showed total bilirubin of 6.5 mg/dl (normal < 1.0) and mild elevations of aminotransferases and alkaline phosphatase. Initial ultrasound of the bile ducts, liver and abdomen did not provide a definitive diagnosis, so a liver biopsy was performed to evaluate "FUO--fever of unknown origin").

Questions

  1. Which lobular regions of the liver are primarily involved in this case?
  2. Does this localization of the histologic findings help you diagnose the type of liver disease present?
  3. What has apparently developed superimposed on the underlying liver disease?
  4. What is the appropriate therapy of this condition?
  5. What is the most common cause of this type of liver biopsy pathology in theU.S.and Europe?

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