Cholestasis

Definition

Cholestasis is any condition in which the flow of bile from the liver is slowed or blocked.

Alternative Names

Intrahepatic cholestasis; Extrahepatic cholestasis

Causes

There are many causes of cholestasis.

Extrahepatic cholestasis occurs outside the liver. It can be caused by:

Bile duct tumors
Cysts affecting the bile duct
Narrowing of the bile duct (strictures)
Stones in the common bile duct
Pancreatitis
Pancreatic tumor or pseudocyst
Pressure on the bile ducts due to a nearby mass or tumor
Primary sclerosing cholangitis

Intrahepatic cholestasis occurs inside the liver. It can be caused by:

Alcoholic liver disease
Amyloidosis
Bacterial abscess in the liver
Being fed exclusively through a vein (IV)
Lymphoma
Pregnancy
Primary biliary cholangitis (previously called primary biliary cirrhosis)
Primary or metastatic liver cancer
Primary sclerosing cholangitis
Sarcoidosis
Serious infections that have spread through the bloodstream (sepsis)
Tuberculosis
Viral hepatitis

Certain medicines can also cause cholestasis, including:

Antibiotics, such as ampicillin and other penicillin
Anabolic steroids
Birth control pills
Chlorpromazine
Cimetidine
Estradiol
Imipramine
Prochlorperazine
Terbinafine
Tolbutamide
Tamoxifen
Steroids
Some chemotherapy agents

Symptoms

Symptoms may include:

Clay-colored or pale stools
Dark urine
Inability to digest certain foods
Itching
Nausea or vomiting
Pain in the right upper part of the abdomen
Yellow skin or eyes

Exams and Tests

Blood tests may show that you have elevated bilirubin and alkaline phosphatase. They are also used to check for other liver conditions and assess how diseased your liver is.

You may need a liver biopsy.

Imaging tests are used to diagnose this condition. Tests include:

CT scan of the abdomen
MRI of the abdomen
Magnetic resonance cholangiopancreatography (MRCP)
Endoscopic retrograde cholangiopancreatography (ERCP), can also determine cause
Ultrasound of the abdomen
DEXA scan of your bones in certain types of cholestasis

Treatment

The underlying cause of cholestasis must be treated. There are medicines to help the itching and other side effects of cholestasis.

Outlook (Prognosis)

How well a person does depends on the disease causing the condition. Stones in the common bile duct can often be removed. This can cure the cholestasis.

Stents can be placed to open areas of the common bile duct that are narrowed or blocked by cancers.

If the condition is caused by the use of a certain medicine, it will often go away when you stop taking that medicine.

Occasionally a liver transplant is needed in severe cases.

Possible Complications

Complications may include:

Diarrhea
Organ failure can occur if sepsis develops
Poor absorption of fat and fat-soluble vitamins
Severe itching
Weak bones (osteomalacia) due to having cholestasis for a very long time

When to Contact a Medical Professional

Contact your health care provider if you have:

Itching that does not go away
Yellow skin or eyes
Other symptoms of cholestasis

Prevention

Get vaccinated for hepatitis A and B if you are at risk. Do not use intravenous drugs and share needles.

References

Eaton JE, Lindor KD. Primary biliary cholangitis. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 91.

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 141.

Lidofsky SD. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 21.