Intrahepatic cholestasis; Extrahepatic cholestasis
Cholestasis is any condition in which the flow of bile from the liver is slowed or blocked.
There are many causes of cholestasis.
Extrahepatic cholestasis occurs outside the liver. It can be caused by:
Bile duct tumors
Narrowing of the bile duct (strictures)
Stones in the common bile duct
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
Bacterial abscess in the liver
Being fed exclusively through a vein (IV)
- Primary biliary cirrhosis
- Primary or metastatic liver cancer
- Primary sclerosing cholangitis
Serious infections that have spread through the bloodstream (sepsis)
- Viral hepatitis
Certain medicines can also cause cholestasis, including:
- Antibiotics such as ampicillin and other penicillins
- Anabolic steroids
- Birth control pills
Symptoms may include:
- Clay-colored or white stools
- Dark urine
- Inability to digest certain foods
- 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
The underlying cause of cholestasis must be treated.
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.
Complications may include:
- 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
Get vaccinated for hepatitis A and B if you are at risk. Do not use intravenous drugs and share needles.
Eaton JE, Lindor KD. Primary biliary chirrhosis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 91.
Fogel EL, Sherman S. Diseases of the gallbladder and liver. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 155.
Lidofsky SD. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 21.