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Cholestasis

Intrahepatic cholestasis; Extrahepatic cholestasis

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

Causes

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 or metastatic liver cancer
  • Primary sclerosing cholangitis
  • Sarcoidosis
  • Serious infections that have spread through the bloodstream (sepsis)
  • Tuberculosis
  • Viral hepatitis

Certain medicines 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

Symptoms may include:

  • 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

Exams and Tests

Blood tests may show that you have elevated 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.

Outlook (Prognosis)

How well a person does depends on the disease causing the condition. Stones in the common bile duct can often be removed. This can cure the cholestasis.

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

If the condition is caused by the use of a certain medicine, it will often go away when you stop taking that drug.

Possible Complications

Complications may include:

  • 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

When to Contact a Medical Professional

Call your health care provider if you have:

  • Itching that does not go away
  • Yellow skin or eyes
  • Other symptoms of cholestasis

Prevention

Get vaccinated for hepatitis A and B if you are at risk. Do not use intravenous drugs and share needles.

References

Eaton JE, Lindor KD. Primary biliary cholangitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 91.

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.

Lidofsky SD. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

Text only

  • Gallstones

    Gallstones - illustration

    The gallbladder is an organ that normally functions to store bile excreted from the liver. Bile is a solution composed of water, bile salts, lecithin, cholesterol and some other small solutes. Changes in the relative concentration of these components may cause precipitation from solution and formation of a nidus, or nest, around which gallstones are formed. Gallstones can become large and block the opening from the gallbladder or cystic duct. This produces pain in the right upper quadrant or midepigastrum (above the belly button) in the abdomen that feels like cramping.

    Gallstones

    illustration

  • Gallbladder

    Gallbladder - illustration

    The gallbladder is a sac located under the liver. It stores and concentrates the bile produced in the liver. Bile is released from the gallbladder in response to food, especially fats, in the upper small intestine.

    Gallbladder

    illustration

  • Gallbladder

    Gallbladder - illustration

    The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

    Gallbladder

    illustration

    • Gallstones

      Gallstones - illustration

      The gallbladder is an organ that normally functions to store bile excreted from the liver. Bile is a solution composed of water, bile salts, lecithin, cholesterol and some other small solutes. Changes in the relative concentration of these components may cause precipitation from solution and formation of a nidus, or nest, around which gallstones are formed. Gallstones can become large and block the opening from the gallbladder or cystic duct. This produces pain in the right upper quadrant or midepigastrum (above the belly button) in the abdomen that feels like cramping.

      Gallstones

      illustration

    • Gallbladder

      Gallbladder - illustration

      The gallbladder is a sac located under the liver. It stores and concentrates the bile produced in the liver. Bile is released from the gallbladder in response to food, especially fats, in the upper small intestine.

      Gallbladder

      illustration

    • Gallbladder

      Gallbladder - illustration

      The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

      Gallbladder

      illustration

     

    Review Date: 5/27/2020

    Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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