Cholestasis: What to Know About This Liver Condition (2024)

Cholestasis is the slowing or stopping of bile secretion and flow. There are numerous conditions that can cause this liver issue. Symptoms include jaundice, itching, and fatigue. Treatment depends on the underlying cause that is affecting bile flow.

This article explains cholestasis, including its symptoms, causes, and treatment options.

Cholestasis describesan impairmentin bile secretion or flow. Bile is a substance that the liver makes. It helps digest fats and carries waste products out of the liver.

After the liver makes it, bile travels through small hepatic ducts or tubes to one large duct: the common hepatic duct. Bile leaves the liver through this duct. Some of the bile goes to the small intestine, and the rest goes to the gallbladder for storage. When you eat food, the gallbladder releases bile for digestion.

A problemeitherin the liver itself (intrahepatic) or in any of the pathways that bile takes outside the liver (extrahepatic) can cause cholestasis. In the liver, the problem can involve bile production, secretion, or flow. Outside the liver, cholestasis involves a blockage at some level of bile flow.

People of all age groups Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source can experience cholestasis. However, children and adolescents are more susceptible to cholestasis while the liver matures.

There are many medical conditions that can cause cholestasis. Certain medications can also affect bile secretion and flow.

Medical conditions can cause acute or chronic cholestasis. When cholestasis lasts longer than3–6 months Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source, it is chronic.

Conditions that can cause cholestasis include:

• bile duct and pancreatic cancer
• bile duct or gallbladder obstruction or stones
• cholangitis, which is inflammation of the bile ducts
• cystic fibrosis and other genetic disorders
• fungal infections
• hepatitis, which is liver inflammation
• intrahepatic cholestasis of pregnancy
• lymphoma, which is a type of blood cancer
• mastocytosis, which is a mast cell disease
• sarcoidosis, which is an inflammatory disease that can affect several organ systems
• sepsis, which is an overwhelming response to an infection
• tuberculosis

Medicationscan injure the liver and give rise to cholestasis.

Drugs and substances that can cause cholestasis include:

• acetaminophen
• alcohol
• anabolic steroids
• antibiotics
• antifungals
• antipsychotics
• cancer chemotherapy
• herbal and complementary medicine supplements
• oral birth control
• total parenteral nutrition

Withacute cholestasis, symptoms start suddenly or rapidly. Chronic cholestasis has a slower onset. However, it is possible to have cholestasis without experiencing any symptoms. A doctor may find the issue during testing for another reason.

Common symptoms Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source include fatigue, itching, and jaundice, which causes yellowing of the eyes and skin.

Other symptoms include:

• abdominal pain
• dark urine
• light or chalky stool
• nausea with or without vomiting
• weight loss
• xanthomas, which are yellow deposits in the skin

Depending on the underlying cause, other symptoms — such as fever — may occur.

Todiagnose cholestasis Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source, doctors take a medical history, review the symptoms, and perform an exam. The exam will pay special attention to the skin and abdomen.

Some tests that doctors may order include:

• blood tests, such as a complete blood count, liver function tests, bleeding times, and fat-soluble vitamin (A, D, E, and K) tests for deficiencies
• imaging exams, such as an abdominal ultrasound, CT scan, or MRI scan
• a liver biopsy, in which a professional takes a tissue sample for laboratory examination

Treatment varies Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to sourcewith the underlying cause.

If a medication is causing the issue, it may be necessary to stop it or find an alternative. If something is blocking the bile duct, a healthcare professional may be able to open the duct and place a stent. Surgery may involve removing stones or removing the gallbladder itself. In cases of severe liver damage, a liver transplant may be an option.

Certain medications can help relieve some of the symptoms of cholestasis, such as itching.

These medications include:

• cholestyramine (Locholest, Prevalite, Questran)
• ursodeoxycholic acid (Actigall, Urso, Ursodiol)
• antihistamines

Preventing cholestasis mainly relies on avoiding the causesof the condition and taking care of your liver.

For example, prevention involves:

• avoiding hepatitis infections by getting vaccinated against them
• avoiding recreational IV drug use
• eating a healthy, balanced diet
• limiting alcohol use
• maintaining a target body weight
• avoiding smoking
• treating any liver diseases

The outlook and complications of cholestasisdepend on Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source the underlying cause.

For benign causes, such as gallstones, the outlook is generally good. For other causes, complications can be serious. End stage liver disease is possible with causes such as cancer and hepatitis.

Intrahepatic cholestasis of pregnancy occurs due to high levels of hormones during pregnancy. It ismost commonin the third trimester, which is when these hormones are at their highest levels.

Symptoms of cholestasis of pregnancy are the same as those of other forms of cholestasis.

Such symptoms include:

• itching
• dark urine
• pale stool
• abdominal pain
• nausea
• fatigue

Risks associated with this condition can be serious and include Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source:

• meconium passage, which is the release of the first feces into the amniotic fluid
  • This puts the fetus at risk of inhaling the contaminated fluid and having breathing problems as a result.
• premature labor
• respiratory distress syndrome in the newborn after birth, which may require breathing support
• stillbirth

The main treatment for cholestasis of pregnancy is the drug ursodeoxycholic acid (Actigall, Urso, Ursodiol).

Doctors also manage delivery timing using bile acid levels. With higher levels, they may recommend inducing an early delivery at 36 weeks of gestation.

Cholestasis is a reduction or stoppage of bile secretion or flow. It can be due to problems with the liver itself or with something outside the liver. Common symptoms include fatigue, itching, and jaundice.

The underlying cause of cholestasis determines its treatment, outlook, and possible complications.