From the Guidelines
Cholestasis is a condition characterized by a reduction or blockage of bile flow from the liver to the small intestine, which can be classified as intrahepatic or extrahepatic, and its diagnosis and management depend on the underlying cause, as outlined in the European Association for the Study of the Liver guidelines 1. Cholestasis can occur due to various reasons, including gallstones, pregnancy, certain medications, liver diseases like primary biliary cholangitis, and structural abnormalities of the bile ducts. Some key points to consider in the diagnosis of cholestasis include:
- Testing for serum antimitochondrial antibodies (AMA) to diagnose primary biliary cholangitis (PBC) 1
- Performing a liver biopsy to evaluate the condition of bile ducts and diagnose disorders involving bile ducts, such as AMA-negative PBC, isolated small duct PSC, and ABCB4 deficiency 1
- Using MRCP or EUS as preferred diagnostic tools over ERCP due to the morbidity and mortality related to ERCP 1 Symptoms of cholestasis typically include:
- Jaundice (yellowing of the skin and eyes)
- Itching (pruritus)
- Pale stools
- Dark urine
- Fatigue Treatment of cholestasis depends on the underlying cause, but may include:
- Ursodeoxycholic acid to improve bile flow
- Cholestyramine to relieve itching
- Procedures to remove blockages like gallstones
- Surgical intervention in severe cases It is essential to note that prolonged cholestasis can lead to liver damage, nutritional deficiencies, and complications from fat-soluble vitamin malabsorption, emphasizing the importance of prompt diagnosis and treatment 1.
From the Research
Definition of Cholestasis
- Cholestasis is a condition characterized by defective canalicular secretion of bile or obstruction to bile flow distal to the canaliculus 2
- It results in the accumulation of bile acids in the hepatocyte, leading to apoptosis, and in the systemic circulation, leading to pruritus and potentially contributing to endothelial injury in the lungs and kidney 2
Pathophysiology of Cholestasis
- In early primary biliary cirrhosis, bile secretion continues due to the secretory pressure of bile or because some ductules are not obstructed 2
- With complete cholestasis, a bile acid deficiency occurs in the small intestinal lumen, leading to lipid maldigestion and fat-soluble vitamin malabsorption 2
- Bacterial proliferation, bacterial translocation to lymph nodes, and endotoxemia may also occur, leading to an acute phase reaction 2
Therapeutic Options for Cholestasis
- Ursodeoxycholic acid (UDCA) is the therapeutic agent most widely used for the treatment of cholestatic hepatopathies 3
- UDCA has multiple mechanisms of action, including stabilizing plasma membranes, halting apoptosis, inducing changes in the expression of metabolizing enzymes and transporters, and preventing the endocytic internalization of canalicular transporters 3
- Cholestyramine is also used to treat cholestasis-induced pruritus, but its use may be limited by its ability to bind to UDCA and reduce its effectiveness 4