Cholestasis a reduction of or stoppage of bile.

[Guest guest]

Cholestasis is reduction or stoppage of bile flow.

* Disorders of the liver, bile duct, or pancreas can cause cholestasis.

* The skin and whites of the eyes look yellow, the skin itches, urine is dark,

and stools may become light-colored ( even grey or white ) and smell foul.

* Laboratory and often imaging tests are needed to identify the cause.

* Treatment depends on the cause, but drugs can help relieve ITCHING

With cholestasis the flow of bile (the digestive fluid produced by the liver) is

impaired at some point between the liver cells and the duodenum (the first

segment of the small intestine). When bile flow is stopped, the pigment

bilirubin (a waste product formed when old or damaged red blood cells are broken

down) escapes into the bloodstream and accumulates.

Causes

The causes of cholestasis are divided into two groups: those originating within

the liver and those originating outside the liver.

Within the Liver: Causes include acute hepatitis, alcoholic liver disease,

primary biliary cirrhosis with inflammation and scarring of the bile ducts,

cirrhosis due to viral hepatitis B or C (also with inflammation and scarring of

the bile ducts) (see Fatty Liver, Cirrhosis, and Related Disorders: Primary

Biliary Cirrhosis), Symptoms

Jaundice, dark urine, light-colored stools, and generalized itchiness are

characteristic symptoms of cholestasis. Jaundice results from excess bilirubin

deposited in the skin, and dark urine results from excess bilirubin excreted by

the kidneys. Retention of bile products in the skin may cause itching, with

subsequent scratching and skin damage. Stools may become light-colored because

the passage of bilirubin into the intestine is blocked. Stools may contain too

much fat (a condition called steatorrhea) because bile cannot enter the

intestine to help digest fat in foods. Fatty stools may be foul-smelling, and

the stool may float. The lack of bile in the intestine also means that calcium

and vitamin D   

are poorly absorbed. If cholestasis persists, a deficiency of these nutrients

can cause loss of bone tissue. Vitamin K, which is needed for blood clotting, is

also poorly absorbed from the intestine, causing a tendency to bleed easily.

Prolonged jaundice due to cholestasis produces a muddy skin color and may

produce fatty yellow deposits in the skin. Whether the person has other

symptoms, such as abdominal pain, loss of appetite, vomiting, or fever, depends

on the cause of cholestasis.

 

 

 

Typically, the blood levels of two enzymes, alkaline phosphatase and

gamma-glutamyl transpeptidase, are very high in people with cholestasis. A blood

test that measures the level of bilirubin indicates the severity of the

cholestasis but not its cause. An imaging study, usually ultrasonography, is

almost always done if blood test results are abnormal. Computed tomography (CT)

or sometimes magnetic resonance imaging (MRI) may be done in addition to or

instead of ultrasonography. If the cause appears to be within the liver, a liver

biopsy. If the cause appears to be blockage of the bile ducts, more precise

images of these ducts are usually needed. Typically, either endoscopic

retrograde cholangiopancreatography (ERCP) or magnetic resonance

cholangiopancreatography (MRCP) is done. MRCP uses magnetic resonance imaging

(see Symptoms and Diagnosis of Digestive Disorders: Computed Tomography and

Magnetic Resonance Imaging). In ERCP, a contrast agent is injected

and x-rays are taken.

Treatment

A blockage of the bile ducts can usually be treated with surgery or endoscopy

(using a flexible viewing tube with surgical instruments attached). A blockage

within the liver may be treated in various ways depending on the cause.

,