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Gastrointestinal

Cholestasis

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Definition

Cholestasis is any condition in which the flow of bile from the liver is slowed or blocked.

Alternative Names

Intrahepatic cholestasis; Extrahepatic cholestasis

Causes, incidence, and risk factors

There are many causes of cholestasis.

Extrahepatic cholestasis occurs outside the liver. It can be caused by:

  • Bile duct tumors
  • Cysts
  • Narrowing of the bile duct (strictures)
  • Stones in the common bile duct
  • Pancreatitis
  • Pancreatic tumor or pseudocyst
  • Pressure on the bile ducts due to a nearby mass or tumor
  • Primary sclerosing cholangitis

Intrahepatic cholestasis occurs inside the liver. It can be caused by:

  • Alcoholic liver disease
  • Amyloidosis
  • Bacterial abscess in the liver
  • Being fed exclusively through a vein (IV)
  • Lymphoma
  • Pregnancy
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Sarcoidosis
  • Serious infections that have spread through the bloodstream (sepsis)
  • Tuberculosis
  • Viral hepatitis

Certain medications can also cause cholestasis, including:

  • Antibiotics such as ampicillin and other penicillins
  • Anabolic steroids
  • Birth control pills
  • Chlorpromazine
  • Cimetidine
  • Estradiol
  • Imipramine
  • Prochlorperazine
  • Terbinafine
  • Tolbutamide

Symptoms

  • Clay-colored or white stools
  • Dark urine
  • Inability to digest certain foods
  • Itching
  • Nausea or vomiting
  • Pain in the right upper part of the abdomen
  • Yellow skin or eyes

Signs and tests

Blood tests may show that you have too much bilirubin and alkaline phosphatase.

Imaging tests are used to diagnose this condition. Tests include:

  • CT scan of the abdomen
  • MRI of the abdomen
  • Endoscopic retrograde cholangiopancreatography (ERCP) (can also determine cause)
  • Ultrasound of the abdomen

Treatment

The underlying cause of cholestasis must be treated.

Expectations (prognosis)

How well a person does depends on the disease causing the condition. Stones in the common bile duct usually can be removed, curing the cholestasis.

Stents can be placed to open areas of the common bile duct that are narrowed or blocked by cancers.

Complications

  • Diarrhea
  • Organ failure can occur if sepsis develops
  • Poor absorption of fat and fat-soluble vitamins
  • Severe itching
  • Weak bones (osteomalacia) due to having cholestasis for a very long time

Calling your health care provider

Call your health care provider if you have:

  • Persistent itching
  • Yellow skin or eyes
  • Other symptoms of cholestasis

Prevention

Get vaccinated for hepatitis A and B if you are at risk. Avoid intravenous drug use and needle sharing.

References

Zollner G, Trauner M. Mechanisms of cholestasis. Clinics in Liver Disease. 2008;12:1-26.

Afdhal NH. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 158.

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