Aetiology of extrahepatic cholestasis

The cause of obstruction of any hollow organ may be divided into luminal, mural and extramural causes:

• obstruction of the lumen of the bile ducts:
  • gall stones
  • parasites:
    • hydatid disease
    • liver fluke
    • round worms
  • iatrogenic:
  • post-T-tube cholangiography
    
    
• mural obstruction:
  • congenital atresia
  • traumatic stricture e.g. ampullary stricture
  • sclerosing cholangitis
  • cholangiocarcinoma
    
    
• extramural obstruction:
  • carcinoma of the head of pancreas
  • carcinoma of the ampulla of Vater
  • pancreatitis
  • porta hepatis tumours (often secondary deposits)
  • chronic duodenal ulceration

The most common causes are:

• gallstones in the bile duct
• carcinoma of the head of the pancreas