Biliary obstruction increases pressures in the bile ducts, leading to reflux of bile into the liver sinusoids, where it may also communicate with the vascular system. If bacteria are present in bile, the patient is at risk for infectious complications (ascending cholangitis, hepatic abscess, sepsis) as well.
Cholestasis and hyperbilirubinemia are associated with an increased incidence of acute kidney injury.
Chronic cholestatic disease in the adult population is primarily the result of immunologic mechanisms resulting in primary biliary cirrhosis or primary sclerosing cholangitis. These diseases are frequently associated with other autoimmune pathology (Crohn disease, psoriasis).