What is Cholestasis (cholestatic liver disease)? Symptoms, Causes and Treatment

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Cholestatic liver disease, commonly called Cholestasis is a disease in which the flow of bile (fluid produced by liver) is blocked or stopped from the originating organ (liver) to duodenum. So, in simple words, blockage of bile flow due to impaired secretions by hepatocytes is called Cholestasis. Moreover, It occurs through intra-or extrahepatic bile ducts.

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What is bile?

Bile is a secretion/fluid that liver produces. It is stored in the gallbladder. This fluid helps in digestion and absorption of fats and fat-soluble vitamins in small intestine. Moreover, Adult human liver produce 400-800 ml bile on the daily basis. Furthermore, bile contains cholesterol, bile acids, Bilirubin, water, body salts etc.

Furthermore, when the flow of bile is altered or tampered, the bilirubin (the waste material after blood cell formation) is released into the blood and gets accumulated, causing the bilirubin level to be elevated. However, there are two types of Cholestasis. As said earlier, the blockage of bile is either intra-or extrahepatic. Meaning, there are two types if Cholestasis; those originating within the liver and those originating out of it.

Intrahepatic:
This Cholestasis is within the liver. However, In the stage of pregnancy when it occurs, it’s called intrahepatic cholestasis of pregnancy.

Cholestasis of pregnancy:
Also known as obstetric Cholestasis, it occurs in the last trimester of pregnancy. Moreover, 1 or 2 in every 1000 pregnant women are likely to get this. The symptom include itching, caused by the accumulation of bile acid in the blood. The symptoms include:

  • Pale stools
  • Nausea
  • Dark urine
  • Pain in abdominal area
  • Jaundice

Is obstetric Cholestasis threatening?
In most most cases, obstetricians Cholestasis is non threatening. However, there can be serious complications for the mother and baby both including stillbirth and preterm delivery.

Extrahepatic:
This Cholestasis occurs outside the liver. A physical barrier causes it in the bile duct that results in the blockage. These barriers can be gallstones, cysts or some tumors.

Causes of Cholestasis (intrahepatic):

  • Pregnancy
  • Lymphoma
  • Primary biliary cirrhosis
  • Tuberculosis
  • Virus induced hepatitis
  • Alcoholic liver disease
  • Tuberculosis
  • Metastatic liver cancer
  • Sarcoidosis
  • Primary biliary cholangitis
  • Amyloidosis
  • Genetic disorders (sickle cell disease)
  • Infections.

Causes of Cholestasis
(extrahepatic):

  • Stictures (narrowing of bile ducts)
  • Cysts formation
  • Tumors in bile duct
  • Pancreatitis (inflammation of pancreas)
  • Formation of stones in bile duct
  • Primary sclerosing cholangitis
  • Pseudocyst in the bile duct
  • Bile duct cancer

Other causes:
Furthermore, medicines and drugs are also the causes of Cholestasis. However, there are some medicines that are difficult for the liver to metabolize. These include:

  • Antibiotics (amoxicillin and minocycline)
  • NSAIDS such as Advil and Motrin IB
  • Birth control pills
  • Chloropromazine
  • Anabolic steroids
  • Terbinafine
  • Antiepileptic drugs
  • Antipsychotic drugs

Symptoms:

Both types of Cholestasis have same symptoms.

  • Excessive itchiness due to accumulation of bile salts.
  • Jaundice (yellow skin color and yellowing of white in eyes)
  • Dark urine
  • Pale stools
  • Muddy skin color
  • Fatigue
  • Nausea
  • Abdominal pain
  • Also, vomiting, loss of appetite and fever

Diagnosis:

Patients who complain about excessive itching without any rash and about abdominal pain are run through some tests. Furthermore, the doctors then find out if the cause if Cholestasis is within the liver or out of it.
Moreover, the tests run for intrahepatic Cholestasis are:

  • Blood tests
  • Ultrasonography
  • Sometimes CT or MRI scan
  • A liver biopsy

Tests for extrahepatic Cholestasis:
Magnetic resonance cholangiopancreatography (MRCP): The bile ducts appear dark in comparison to surrounding tissues. Furthermore, this gives an image of blockage problem. Moreover, it provides ease to discover the problem.
Endoscopic retrograde cholangiopancreatography (ERCP): X-rays are taken after an endoscope is lowered into the intestine via mouth. Moreover, a radiopaque agent goes in the intestine. Moreover, they take x-rays.
Endoscopic ultrasonography: Endoscope is inserted in to the intestine via mouth. Moreover, an ultrasound probe obtains the images after inserting in the intestine.

Treatment:

There are different treatments for the two types of Cholestasis. For intrahepatic, the doctor may recommend medication or drug. For extrahepatic, the doctor will most probably recommend surgery and endoscopy too. Furthermore, the blockage in the bile duct can be treated through surgery or endoscopy as discussed on the diagnosis. The blockage within the liver is treated with a drug depending on the cause too. Also, alcohol and drugs that damage liver must not be used at all. Also, Cholestyramine is cure for itchiness. Calcium, vitamin D and K are important to cure it as well. Moreover, obstetric Cholestasis cure is usually after giving birth. Furthermore, good and enhanc nutrition is a cure for jaundice. Moreover, with iron supplements in the lowest case of jaundice.