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Cholestasis

Definition

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

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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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