cholestasis
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Introduction
Absence or reduction of bile flow from the liver.
Etiology
- biliary tract obstruction
- drug-induced cholestasis
- right-sided heart failure
- cholestasis of pregnancy
- hepatobiliary neoplasms
- primary benign & malignant tumors
- metastatic tumors
- primary biliary cirrhosis
- cholangitis
Genetics
- defects in ABCB11 may cause chronic intrahepatic cholestasis without obvious familial history of chronic liver disease
- genetic variations in ABCB11 may play a role in drug-induced cholestasis
Clinical manifestations
- pruritus may precede biochemical abnormalities
- jaundice
- severe cholestasis may result in steatorrhea
Laboratory
- liver function tests
- significantly elevated alkaline phosphatase & gamma-glutamyltransferase
- mildly abnormal aminotransferases
- endoscopic retrograde cholangiopancreatography (ERCP)
- liver biopsy
Radiology
- ultrasound imaging of liver & biliary tract
- computed tomography (CT) can identify mass lesions of the liver & biliary tree
- cholangiography
Management
- vitamin K SC may improve PT in the absence of hepatic dysfunction
- decompression with relief of extrahepatic obstruction
- pruritus due to intrahepatic obstruction
- cholestyramine
- antihistamine
- ursodeoxycholic acid or ursodiol (Actigall)
- especially useful in patients with primary biliary cirrhosis
- phototherapy with UV-B radiation
More general terms
More specific terms
- benign recurrent intrahepatic cholestasis (BRIC, Summerskill syndrome)
- cholestatic hepatitis
- familial intrahepatic cholestasis
- intrahepatic cholestasis of pregnancy (obstetric cholestasis)