Cholestasis: Causes, Symptoms, Diagnosis, Treatment, and Prevention
In Cholestasis, the flow of bile from the liver to the small intestine is reduced or blocked. When the flow of bile is disrupted, it can lead to problems in the liver, digestive system, and other organs. Bile is a liquid that helps digest fats and fat-soluble vitamins, as well as carries waste products out of the body.
Causes of Cholestasis
There are many possible causes of cholestasis, which can be classified into two types:
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The liver cells produce and secrete bile, so intrahepatic cholestasis occurs when the problem occurs. It can be caused by liver diseases, such as hepatitis, cirrhosis, or liver cancer, genetic conditions, such as cystic fibrosis, or alpha-1 antitrypsin deficiency; pregnancy, particularly during the third trimester; or certain medications.
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Gallstones, tumors, inflammation, infection, or injury can block or narrow the bile ducts that transport bile from the liver to the gallbladder and small intestine, causing extrahepatic cholestasis.
Symptoms of Cholestasis
The most common symptoms of cholestasis are:
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Jaundice: This is a yellowing of the skin and the whites of the eyes, caused by the buildup of bilirubin, a pigment that is normally excreted in bile.
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Itching: This is a result of bile salts and other substances accumulating in the skin, causing irritation and inflammation.
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Dark urine: This is due to the excess bilirubin being filtered by the kidneys and passing into the urine.
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Pale or clay-colored stools: This is because of the lack of bile reaching the intestines, which normally gives stools their brown color and helps digest fats.
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Other symptoms may include abdominal pain, nausea, vomiting, loss of appetite, weight loss, fatigue, fever, and malabsorption of nutrients.
Diagnosis of Cholestasis
The doctor will examine the patient's medical history, symptoms, and medications in order to diagnose cholestasis. A physical examination will be performed by the doctor to check for signs of jaundice, enlarged liver and spleen, and abdominal tenderness. Tests may be ordered by the doctor, including:
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These tests check bilirubin levels, liver enzymes, and other markers of liver function and inflammation, as well as for signs of infection, anemia, and clotting problems.
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Urine tests: These can detect the presence of bilirubin or bile salts in the urine, which indicate cholestasis.
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Tests of imaging are used to examine the liver and the bile ducts, and to detect blockages, tumors, or stones. Among them are ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography (ERCP).
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A liver biopsy involves taking a small sample of liver tissue and examining it under a microscope. It can help determine the cause and severity of liver damage.
Treatment of Cholestasis
Some of the possible treatments for cholestasis depend on the underlying cause and the severity of the condition. The main goals of treatment are to relieve symptoms, prevent complications, and treat the cause.
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A wide variety of medications can be used to reduce itching, such as antihistamines, cholestyramine, or ursodeoxycholic acid; to dissolve gallstones, such as ursodeoxycholic acid or chenodeoxycholic acid; to treat infections with antibiotics or antivirals; or to treat inflammation with steroids or immunosuppressants.
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It may be necessary to undergo surgery to remove gallstones, tumors, or scar tissue blocking the bile ducts, or to repair any damage to the bile ducts. For patients with severe or irreversible liver damage, a liver transplant may be the only option.
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In addition to eating a healthy low-fat, high-fiber diet, drinking plenty of fluids, avoiding alcohol and tobacco, and exercising regularly, lifestyle changes can improve liver function, prevent constipation, and reduce complications.
Prevention of Cholestasis
Some of the ways to prevent cholestasis are:
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Maintaining a healthy weight and avoiding obesity, which can increase the risk of gallstones and fatty liver disease.
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Limiting alcohol intake and avoiding illicit drugs, which can damage the liver and impair bile production and flow.
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Following the doctor's instructions and monitoring the liver function when taking medications that can cause cholestasis, such as antibiotics, steroids, or oral contraceptives.
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Seeking medical attention promptly if experiencing any symptoms of cholestasis, such as jaundice, itching, dark urine, or pale stools.
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Getting regular check-ups and screening tests for liver diseases, especially if having a family history or a genetic predisposition to cholestasis.
