Everything You Need to Know About Cholestasis (2024)

Cholestasisis a reduction or cessation of the flow of bile. It commonly occurs in pregnancy but can also happen in males and females who are not pregnant.It is caused by impairment of bile secretion from the liver cells, an obstruction that blocks the flow of bile, or a combination of the two.

Cholestasis can cause the skin and the whites of the eyes to appear yellow. It may also cause itchy skin, fatigue, nausea, and foul-smelling stools. The condition can affect people of all ages.

This article discusses cholestasis and what causes it. It also covers how this condition is diagnosed and treated.

What Is Cholestasis?

Cholestasishappens when the flow of bile from the liver slows or stops. Bile is a greenish-brown fluid that aids in digestion and is secreted by the liver and stored in the gallbladder, the small sac-shaped organ beneath the liver.It is critical to the body for normal digestion and absorption of fats and fat-soluble vitamins such as vitamin D and vitamin K.

When bile doesn't flow properly, it can cause inflammation or problems in your digestive system.

The lack of any of the substances that are normally secreted into bile can causecholestasis.These substances include:

• Water
• Cholesterol
• Lecithin
• Bilepigments (bilirubinandbiliverdin)
• Bileacids, which are critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine.
• Bile salts
• Copperand other excreted metals (in small amounts)

Cholestasiscan occur in men and women of any age.

Cholestasis Symptoms

Bile works in the small intestine to help break down and absorb fats into the body. Whencholestasisoccurs, the flow of bile is impaired at some point between the liver and the small intestine.

When the flow of bile is blocked or reduced for any reason,bilirubinbegins to escape into the bloodstream and starts to build up. This eventually causes a yellowish hue to the skin and whites of the eyes, as found in jaundice. Jaundice occurs due to the excess in bilirubin pigment.

Other symptoms may include:

• Darkurine
• Foul-smelling and/or light-colored stool from a blockage ofbilirubinin the intestine
• Steatorrhea, too much fat in the stool from the inability of the bile to digest fats in the intestine
• Abdominalpain
• Fatigue

If the condition persists long-term (chronic), symptoms can include:

• Lowcalcium and vitamin D levels and other nutrients
• Muddy-colored skin
• Fatty, yellow deposits in the skin

Depending on the cause, othersymptoms may include nausea, vomiting, or fever. Adultswith long-term cholestasisare often free of symptoms.

Complications

If cholestasis is left untreated, it can lead to complications, some of which are life-threatening. These include:

• Diarrhea
• Severe itching
• Poor absorption of fat and vitamins
• Weakened bones
• Organ failure
  

Cholestasis Causes

Various conditions of the liver, the pancreas, or the ducts that carry bile from the liver and gallbladder can cause a decrease in the flow of bile and result incholestasis. An obstruction in the flow of any of the substances that make up bile can result incholestasis.

Causes Affecting Your Liver

Many of the conditions that can cause cholestasis affect the liver directly. These include:

• Acutehepatitis
• Alcohol-induced liver disease
• Druguse
• Geneticabnormalities
• Livercirrhosis due to viral hepatitis B or C, when scar tissue replaces normal liver tissue long-term damage causes the liver to no longer function properly
• Anycondition that results in inflammation or scarring of the bile ducts (such as hepatitis)
• Hormoneeffects on bile flow such as during pregnancy (a specific condition called cholestasis of pregnancy)
• Cancerthat involves the liver
• Certain prescription medications

Causes Outside the Liver

Conditions that affect the bile ducts or the pancreas can also cause cholestasis, including:

• Astone in the bile duct causing a narrowing and obstruction of bile flow (gallstones)
• Cancerof the bile duct (tumors that restrict bile flow)
• Cyststhat restrict the flow of bile
• Inflammationof the pancreas (pancreatitis)
• Cancerof the pancreas

Medication Causes

The liver removes toxic substances such as those in many drugs, including prescription medications.Some medications are harder for the liver tobreak downand may even become toxic to it. Medications that can damage the liver include:

• Analgesics including paracetamol, aspirin, and non-steroidal anti-inflammatory drugs (such as Motrin)
• Cardiac (heart) drugs: methyldopa, amiodarone
• Psychotropic drugs: MAO inhibitors, phenothiazines (such as chlorpromazine)
• Other drugs: sodium valproate, estrogens (oral contraceptives and hormone replacement therapy)

Diagnosing Cholestasis

A complete medical history and physical exam will be part of a diagnostic assessment forcholestasis.When someone has symptoms of jaundice, the primary goal of diagnosis is to determine whether the cause comes from inside or outside of the liver.

There are many tests used to diagnosecholestasis, including lab tests such as:

• Bloodtests such asbilirubinlevels to measure the severity ofcholestasis, but not the cause
• Liver function tests to evaluate whether the liver is properly functioning and measure certain enzymes that are high in people withcholestasis
• Imagingtests, such asultrasonography, CT scan, and/or an MRIto positively establish the underlying cause ofcholestasis
• Liverbiopsy to check for liver cancer in some instances

If the cause of cholestasis is a blockage of the bile ducts, more precise images of the ducts will be needed via a procedure using a flexible tube with a viewing tube called an endoscope.

Cholestasis Treatment

Treatment ofcholestasisdepends on the underlying cause. These include:

• Medication,such ascholestyramine, to relieve the itching of the skin
• Surgeryor endoscopy (a flexible viewing tube with a surgical instrument attached) to correct blockages of the bile duct
• VitaminK administration to improve blood clotting (unless there is severe liver damage)
• Cessation of any prescription medications that could be toxic to the liver
• Discontinuingany illicit substance that is toxic to the liver (such as alcohol and drugs)
• VitaminD or other supplements
• Cholesterolmedication
• Cholecystectomy(removal of the gallbladder)
• Biliarystenting(to allow proper flow of bile)
• Lithotripsy(to break up any gallbladder stones)
• Consultationwith a hepatologist (liver specialist) or other specialists

If hepatitis is the underlying cause,cholestasiswill subside once the hepatitis is cleared up.

Prevention

Cholestasis can't always be prevented, but there are some things you can do to prevent the most common causes of the condition:

• Get the hepatitisvaccine.
• Avoidheavy drinking or drug use, especially IV drugs.
  
• Avoiddiets that are high in fat and cholesterol and low in fiber as well as quick weight loss diets, especially if you have been previously diagnosed with gallstones.

Outlook

Recovery fromcholestasisis dependent on many factors including the underlying cause and how severe the condition was before itsdiagnosis.

If the cause of cholestasis is a blockage from gallstones, those can be surgically removed, and relatively quick and full recovery can be expected.If the cause is damage to the liver from chronic alcohol use, the result may be liver cirrhosis, which may be too severe to expect any type of quick recovery.

Seekmedical attention as soon as possible if you have any early signs ofcholestasissuch as jaundice and itchy skin. Be sure to discuss your individual case and your options with your healthcare provider.

Summary

Cholestasis occurs when the flow of bile from the liver stops or slows. When this happens, the bile can back up into the organs and cause problems like inflammation, jaundice, and digestive issues.

Symptoms of cholestasis include a yellowing of the skin and eyes, itching, fatigue, and nausea. Treatment depends on the cause of the condition. Some cases of cholestasis are curable with surgery and others require long-term management.