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Figure 1 | Critical Care

Figure 1

From: Clinical review: The liver in sepsis

Figure 1

Cellular mechanisms of sepsis-associated cholestasis. (a) Hepatocyte capture and transport of bilirubin and biliary salts. (b) Pathophysiological alterations in sepsis: (1) downregulation of sodium taurocholate cotransporting polypeptide (NTCP); (2,3) reduction of the canalicular export pumps, bile salt export pump (BSEP) and multidrug resistant-associated protein 2 (MRP2); (4) disruption of the structural and functional integrity of the tight junctions; and (5) cytoskeleton alteration surrounding the canaliculus, inducing its distension and a decrease in canalicular duct contractibility. Alb, albumin; CB, conjugated bilirubin; CYP, cytochrome P450; ER, endoplasmic reticulum; GST, glutathione transferase; LP, lipoprotein; OATP, organic anion-transporting polypeptide; UB, unconjugated bilirubin; UDP-GT, uridine diphosphate glucuronosyltransferase.

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