toxic bile acids) is retained in the liver This leads to liver discoloration but no other liver toxicity Obstruction: When the biliary tree becomes obstructed, liver damage results The classic example is BA, where bile salts back up into the liver and induce rapid fibrosis, cirrhosis, and eventual end-stage liver disease (See Table 44.1 ) FIGURE 44.1 Approach to the patient with conjugated hyperbilirubinemia