Medically Reviewed By Youssef (Joe) Soliman, MD
— Written By Sarah Lewis, PharmD
Updated on May 20, 2022
This article explains cholestasis, including its symptoms, causes, and treatment options.
What is cholestasis?
Cholestasis describesan impairmentin bile secretion or flow. Bile is a substance that the liver makes. It helps digest fats and carries waste products out of the liver.
After the liver makes it, bile travels through small hepatic ducts or tubes to one large duct: the common hepatic duct. Bile leaves the liver through this duct. Some of the bile goes to the small intestine, and the rest goes to the gallbladder for storage. When you eat food, the gallbladder releases bile for digestion.
A problemeitherin the liver itself (intrahepatic) or in any of the pathways that bile takes outside the liver (extrahepatic) can cause cholestasis. In the liver, the problem can involve bile production, secretion, or flow. Outside the liver, cholestasis involves a blockage at some level of bile flow.
People of
What causes cholestasis?
There are many medical conditions that can cause cholestasis. Certain medications can also affect bile secretion and flow.
Conditions that can cause cholestasis
Medical conditions can cause acute or chronic cholestasis. When cholestasis lasts longer than
Conditions that can cause cholestasis include:
- bile duct and pancreatic cancer
- bile duct or gallbladder obstruction or stones
- cholangitis, which is inflammation of the bile ducts
- cystic fibrosis and other genetic disorders
- fungal infections
- hepatitis, which is liver inflammation
- intrahepatic cholestasis of pregnancy
- lymphoma, which is a type of blood cancer
- mastocytosis, which is a mast cell disease
- sarcoidosis, which is an inflammatory disease that can affect several organ systems
- sepsis, which is an overwhelming response to an infection
- tuberculosis
Medications that can cause cholestasis
Medicationscan injure the liver and give rise to cholestasis.
Drugs and substances that can cause cholestasis include:
- acetaminophen
- alcohol
- anabolic steroids
- antibiotics
- antifungals
- antipsychotics
- cancer chemotherapy
- herbal and complementary medicine supplements
- oral birth control
- total parenteral nutrition
What are the symptoms of cholestasis?
Withacute cholestasis, symptoms start suddenly or rapidly. Chronic cholestasis has a slower onset. However, it is possible to have cholestasis without experiencing any symptoms. A doctor may find the issue during testing for another reason.
Other symptoms include:
- abdominal pain
- dark urine
- light or chalky stool
- nausea with or without vomiting
- weight loss
- xanthomas, which are yellow deposits in the skin
Depending on the underlying cause, other symptoms — such as fever — may occur.
How do doctors diagnose cholestasis?
To
Some tests that doctors may order include:
- blood tests, such as a complete blood count, liver function tests, bleeding times, and fat-soluble vitamin (A, D, E, and K) tests for deficiencies
- imaging exams, such as an abdominal ultrasound, CT scan, or MRI scan
- a liver biopsy, in which a professional takes a tissue sample for laboratory examination
What are the treatments for cholestasis?
If a medication is causing the issue, it may be necessary to stop it or find an alternative. If something is blocking the bile duct, a healthcare professional may be able to open the duct and place a stent. Surgery may involve removing stones or removing the gallbladder itself. In cases of severe liver damage, a liver transplant may be an option.
Certain medications can help relieve some of the symptoms of cholestasis, such as itching.
These medications include:
- cholestyramine (Locholest, Prevalite, Questran)
- ursodeoxycholic acid (Actigall, Urso, Ursodiol)
- antihistamines
Is it possible to prevent cholestasis?
Preventing cholestasis mainly relies on avoiding the causesof the condition and taking care of your liver.
For example, prevention involves:
- avoiding hepatitis infections by getting vaccinated against them
- avoiding recreational IV drug use
- eating a healthy, balanced diet
- limiting alcohol use
- maintaining a target body weight
- avoiding smoking
- treating any liver diseases
What are the possible complications of cholestasis?
The outlook and complications of cholestasis
For benign causes, such as gallstones, the outlook is generally good. For other causes, complications can be serious. End stage liver disease is possible with causes such as cancer and hepatitis.
Is cholestasis of pregnancy serious?
Intrahepatic cholestasis of pregnancy occurs due to high levels of hormones during pregnancy. It ismost commonin the third trimester, which is when these hormones are at their highest levels.
Symptoms of cholestasis of pregnancy are the same as those of other forms of cholestasis.
Such symptoms include:
- itching
- dark urine
- pale stool
- abdominal pain
- nausea
- fatigue
Risks associated with this condition can be serious and
- meconium passage, which is the release of the first feces into the amniotic fluid
- This puts the fetus at risk of inhaling the contaminated fluid and having breathing problems as a result.
- premature labor
- respiratory distress syndrome in the newborn after birth, which may require breathing support
- stillbirth
The main treatment for cholestasis of pregnancy is the drug ursodeoxycholic acid (Actigall, Urso, Ursodiol).
Doctors also manage delivery timing using bile acid levels. With higher levels, they may recommend inducing an early delivery at 36 weeks of gestation.
Summary
Cholestasis is a reduction or stoppage of bile secretion or flow. It can be due to problems with the liver itself or with something outside the liver. Common symptoms include fatigue, itching, and jaundice.
The underlying cause of cholestasis determines its treatment, outlook, and possible complications.