Cholestasis

Relative incidences of causes of neonatal cholestasis

Hepatocyte transporters implicated in DIC

Cholestasis Diagnosis

Cholestasis is a medical condition characterized by the impairment of bile flow from the liver to the duodenum, which can lead to a buildup of bile acids in the liver and bloodstream. This condition can be caused by a variety of factors, including liver diseases, bile duct obstructions, and certain medications. Cholestasis can occur within the liver (intrahepatic) or outside the liver (extrahepatic).

Causes

Cholestasis can be caused by several factors, which can be broadly classified into intrahepatic and extrahepatic causes. Intrahepatic causes include conditions that affect the liver cells directly, such as hepatitis, alcoholic liver disease, and genetic disorders like Progressive familial intrahepatic cholestasis. Extrahepatic causes are related to obstructions in the bile ducts, such as gallstones, cholangiocarcinoma (bile duct cancer), and pancreatic cancer.

Symptoms

The symptoms of cholestasis can vary depending on the underlying cause and severity of the condition. Common symptoms include jaundice (yellowing of the skin and eyes), dark urine, pale stool, itching (pruritus), and abdominal pain. Long-term cholestasis can lead to complications such as vitamin deficiencies due to poor absorption of fat-soluble vitamins (A, D, E, K), osteoporosis, and malnutrition.

Diagnosis

The diagnosis of cholestasis involves a combination of clinical evaluation, laboratory tests, and imaging studies. Blood tests can reveal elevated levels of liver enzymes, bilirubin, and bile acids. Imaging studies such as ultrasound, CT scan, and MRI can help identify blockages in the bile ducts. In some cases, a liver biopsy may be necessary to determine the cause of intrahepatic cholestasis.

Treatment

Treatment of cholestasis aims to address the underlying cause of the condition. For extrahepatic cholestasis caused by bile duct obstructions, treatments may include surgical removal of the obstruction, endoscopic procedures to clear the bile ducts, or the placement of stents to keep the ducts open. In cases of intrahepatic cholestasis, treatment options may include medications to improve bile flow, such as ursodeoxycholic acid, and managing the symptoms, such as using antipruritics for itching. In severe cases, a liver transplant may be considered.

Prevention

Preventing cholestasis involves managing risk factors and underlying conditions that can lead to bile duct obstruction or liver damage. This includes maintaining a healthy lifestyle, avoiding excessive alcohol consumption, and managing cholesterol levels to prevent gallstone formation.