Cholestasis

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Cholestasis
ICD-10	K71.0, K83.1
ICD-9	576.2
DiseasesDB	9121
eMedicine	ped/383
MeSH	D002779

Cholestasis Microchapters
Home
Patient Information
Overview
Pathophysiology
Causes
Differentiating Cholestasis from other Diseases
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Cholestasis On the Web
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cited articles
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American Roentgen Ray Society Images of Cholestasis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Cholestasis
CDC on Cholestasis
Cholestasis in the news
Blogs on Cholestasis
Directions to Hospitals Treating Cholestasis
Risk calculators and risk factors for Cholestasis

Diagnosis

History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics

Treatment

Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies

Etiology

• Gallstones
• Abdominal mass (e.g. cancer)
• Primary sclerosing cholangitis, secondary to inflammatory bowel disease
• Primary biliary cirrhosis, secondary to autoimmune disorders
• Congenital anomalies of the bilary tract
• Biliary trauma
• Some drugs, (e.g. Flucloxacillin and Erythromycin)
• In children, biliary atresia and other pediatric liver diseases
• Pregnancy, referred to as Intrahepatic Cholestasis of Pregnancy, or Obstetric Cholestasis

Histopathology

Under a microscope, the individual hepatocytes will have a brownish-green stippled appearance within the cytoplasm, representing bile that cannot get out of the cell. Canalicular bile plugs between individual hepatocytes or within bile ducts may also be seen, representing bile that has been excreted from the hepatocytes but cannot go any further due to the obstruction. When these plugs occur within the bile duct, sufficient pressure (caused by bile accumulation) can cause them to rupture, spilling bile into the surrounding tissue, causing hepatic necrosis. These areas are known as bile lakes, and are typically seen only with extra-hepatic obstruction.

Symptoms

• Pale stools,
• dark urine,
• itchiness (pruritus) and
• jaundice.

Bile is secreted by the liver to aid in the digestion of fats. Drugs such as gold salts,nitrofurantoin, anabolic steroids, chlorpromazine, prochlorperazine, sulindac, cimetidine, erythromycin, can cause cholestasis and may result in damage to the liver.

Differential Diagnosis of Cholestasis

• After liver transplantation
• After ulcer surgery
• Alagille Syndrome
• Alcoholic Hepatitis
• Alpha-1 Antitrypsin Deficiency
• Amebiasis
• Amyloidosis
• Bile duct carcinoma
• Bile duct calculi
• Bile duct cysts
• Biliary atresia
• Budd-Chiari Syndrome
• Bylers Syndrome
• Carbonic anhydrase inhibitors
• Caroli's Syndrome
• Cholangiocellular carcinoma
• Cholecystectomy
• Choledochotomy with T-tube drainage
• Chronic active hepatitis
• Cryptosporidiosis
• Cystic Fibrosis
• Drugs
• Dubin-Johnson Syndrome
• Duodenal abscess
• Echinococcosis
• Familiar progressive cholestasis
• Hemochromatosis
• Hydatid cyst
• Idiopathic postoperative jaundice
• Idiopathic relapsing cholestasis
• Impaired bile acid synthesis
• Intermittent cholestasis
• Ischemia of other origin
• Leptospirosis
• Liver abscess
• Liver Cancer
• Liver cysts
• Liver metastases
• Lymphoma
• Mirizzi's Syndrome
• Neoplasm
• Pancreatic Cancer
• Pancreatic cyst
• Pancreatitis
• Pancreatoduodenectomy
• Papillary carcinoma
• Parasites
• Parasitosis
• Pericholedochal infection
• Postoperative
• Pregnancy cholestasis
• Primary and secondary sclerosing cholangitis
• Primary biliary cirrhosis
• Primary sclerosing cholangitis
• Rare congenital causes
• Relapsing cholangitis
• Reye's Syndrome
• Sarcoidosis
• Sepsis
• Sickle Cell Anemia
• Stenosis of the bile papilla
• Stricture
• Total parenteral nutrition
• Toxic, allergic
• Toxic Shock Syndrome
• Viral Hepatitis
• Wilson's Disease
• Zieve's Syndrome

See also

• Jaundice
• Liver function tests
• Lipoprotein-X - an abnormal low density lipoprotein found in cholestasis
• Intrahepatic Cholestasis of Pregnancy

External links

• Drug-induced cholestasis - medlineplus.org
• Liver Families = pediatric liver support group
• Itchy Moms - information about Obstetric Cholestasis / Cholestasis of Pregnancy
• OC Support website - OC Support website: information about Obstetric Cholestasis, research, support, shared experiences, discussion forum.

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