Cholestasis

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Overview

Cholestasis is defined as stagnation, or at least a marked reduction, in bile secretion and flow. Cholestasis can be due to a functional impairment of the hepatocytes in the secretion of bile and/or due to an obstruction at any level of the excretory pathway of bile, from the level of the hepatic parenchymal cells at the basolateral (sinusoidal) membrane of the hepatocyte to the ampulla of Vater in the duodenum. Cholestatic jaundice can thus be classified into intrahepatic or extrahepatic cholestasis, depending upon the level of obstruction to bile flow. Intrahepatic cholestasis or functional cholestasis can be due to a disease involving the liver parenchymal cells and/or the intrahepatic bile ducts. Intrahepatic cholestasis can be further subclassified as intralobular (disease of liver parenchymal cells and transporter molecules) and extralobular (disease involving intrahepatic bile ducts) cholestasis. Extrahepatic cholestasis or obstructive cholestasis is due to excretory block outside of the liver, along with the extrahepatic bile ducts .

Clinically, cholestasis leads to retention of the constituents of bile in blood. The 2 major constituents of bile are bilirubin and bile acids. Thus biochemically, cholestasis is marked by the elevation of predominantly serum alkaline phosphatase. Histologically, the retention of bilirubin in the hepatocytes, bile canaliculi, or bile ducts causes bilirubinostasis and is clinically manifested as jaundice. The stagnation of bile acids, on the other hand, causes typical changes in the periportal region of the liver which is termed as cholate stasis and presents clinically as pruritus. As the excretion of bilirubin follows hepatocellular pathways different from those of bile acids, serum bilirubin level may be normal in certain cases of severe cholestasis (anicteric cholestasis), and the patient may present with only pruritus but no jaundice. Prominent features of cholestasis are pruritus and malabsorption of fat and fat-soluble vitamins.

Symptoms

Both types of cholestasis result in the same symptoms:


jaundice, which is a yellowing of your skin and the white of your eyes

dark urine

light-colored stool

pain in your abdomen

fatigue

nausea

excessive itching

Not everyone with cholestasis has symptoms, and adults with chronic cholestasis are oftenTrusted Source symptom-free.


Causes

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.

Risk factors

Cholestasis that occurs during pregnancy can be an inherited condition. If your mother or sister had this condition during pregnancy, you may have an increased risk for also developing obstetric cholestasis.


Pregnancy hormones may also cause this condition. That’s because they can affect your gallbladder function, allowing bile to build up and flow over into your bloodstream.


Women carrying multiples are at higher risk of obstetric cholestasis.


Read more: How does pregnancy affect the gallbladder? »


Is obstetric cholestasis dangerous?

Obstetric cholestasis can be a serious condition for both mom and baby. While most cases are nonthreatening, it can cause serious complications, including:


preterm delivery

fetal distress

stillbirth

Most cases of obstetric cholestasis resolve after delivery. The condition can affect your health in the long term, however. In research published in the Journal of Hepatology, women who had cholestasis during pregnancy had a three times greater risk of liver cancer later in life than women who didn’t have cholestasis while pregnant. They also had increased risk of:


cancer of the biliary system

thyroid disease

diabetes

Crohn’s disease


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Complications

The complications of cholestatic liver disease affect a number of extrahepatic organ systems. Although many of these, such as mineral bone disease, dyslipidemia, and fat-soluble vitamin deficiency, are found with laboratory screening, others, such as pruritus, are often found only upon asking.

Prevention

You cannot prevent cholestasis of pregnancy. Genetic testing may help you understand the chance of passing this disorder on to your child.