Cholestasis is a condition when the flow of bile is slowed or obstructed. Cholestasis generally causes symptoms in the form of yellowing of the skin ( jaundice ) and itching even though no rash appears. If not treated immediately, cholestasis risks causing damage to the liver.

Bile is a liquid produced by the liver and stored in the gallbladder. Bile functions to assist the digestive tract in breaking down fat and absorbing vitamins. In a day, the liver can produce around 800-1,000 ml of bile.

Bile contains a yellow-brown substance called bilirubin. Normally, bilirubin will flow with bile into the digestive tract, then excreted through feces and urine.

Cholestasis occurs when the flow of bile is obstructed so that bilirubin will exit the bile ducts and enter the bloodstream. As a result, bilirubin will accumulate in the bloodstream, then cause symptoms, such as yellowing of the skin and whites of the eyes.

Causes of Cholestasis

Cholestasis can be caused by a variety of conditions. The following are some of the causes of cholestasis as well as explanations:

Intrahepatic causes

Cholestasis can be caused by disorders of the liver, such as:

  • Acute hepatitis
  • Liver cirrhosis due to hepatitis B or C virus
  • Alcohol-related liver disease
  • Inflammation of the bile ducts
  • Genetic disorders, such as Dubin-Johnson syndrome or Rotor syndrome
  • Liver cancer or spread of cancer to the liver

Extrahepatic causes

Apart from disorders of the liver, cholestasis can also be caused by disorders from outside the liver, including:

  • Gallstones
  • Bile duct cancer
  • Bile duct narrowing
  • Inflammation of the pancreas ( pancreatitis )
  • Pancreatic cancer

Medication side effects

The liver can help remove toxic substances in medicines. However, there are some drugs that are more difficult for the liver to absorb, so their poison can be harmful to the liver. Some of these drugs are:

  • Antibiotics, such as amoxicillin and penicillin
  • Analgesics, such as paracetamol and aspirin
  • Antipsychotics, such as phenothiazines
  • Heart disease medications, such as amiodarone
  • Other medications, such as birth control pills and estrogen

In rare cases, cholestasis can also be experienced by pregnant women. This condition is known as intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis.

Cholestasis Symptoms

In some cases, cholestasis does not cause symptoms, especially in adult patients who have suffered from cholestasis for a long time. However, there are some general symptoms that can arise due to cholestasis, namely:

  • Yellowing of the skin and whites of the eyes ( jaundice )
  • Dark urine like tea
  • Pale stools
  • Unbearable itching
  • Extreme fatigue
  • Upper right abdominal pain
  • Loss of appetite
  • Nausea and vomiting

When to see a doctor

Immediately to the doctor if you feel itching that does not go away, or your skin and the whites of your eyes turn yellow. Both of these symptoms are typical signs of cholestasis, so they need to be examined immediately to prevent complications.

Diagnosis of Cholestasis

The doctor will ask questions and answers about symptoms and medical history, as well as medicines consumed by the patient. After that, the doctor will carry out a physical examination, including looking at the skin and the whites of the eyes for yellowing.

To make a diagnosis, the doctor will carry out supporting examinations, such as:

  • Blood tests , to check liver function, and measure levels of bilirubin, alkaline phosphatase (AFP), and gamma glutamyl transpeptidase (GGT)
  • Ultrasound and CT scan of the abdomen, to detect causes of obstruction to the flow of bile, such as cysts
  • MRCP ( magnetic resonance cholangiopancreatography ), to see the condition of the bile ducts and pancreas by making the fluid in the ducts look brighter
  • Liver biopsy , to determine the underlying cause of cholestasis
  • ERCP ( endoscopic retrograde cholangiopancreatography ), to see the condition of the bile ducts and pancreas using a small camera (endoscope)

Cholestasis Treatment

Treatment of cholestasis is adjusted to the underlying cause. If cholestasis occurs due to certain drugs, the doctor will ask the patient to stop using the drug.

Some examples of other treatments that are adjusted to the cause are:

  • Surgery, to overcome blockages in the bile ducts
  • Giving vitamin K , to overcome the occurrence of blood clots
  • Gallbladder removal surgery (cholecystectomy), to remove the gallbladder
  • Placement of stents in the bile ducts, to open narrowed channels

Apart from treating the cause, doctors can also prescribe cholestyramine , to relieve itching on the skin.

Cholestatic complications

If left untreated, cholestasis can cause several complications, namely:

  • Liver damage
  • Severe skin problems
  • Bone disorders, such as osteopenia, osteoporosis , and osteomalacia, due to impaired fat absorption
  • Blood clotting disorders

Cholestasis Prevention

There are several things that can be done to reduce the risk of cholestasis, namely:

  • Get vaccinated against hepatitis A and B.
  • Avoid excessive consumption of alcoholic beverages.
  • Do not abuse drugs , especially those using needles.
  • Wash your hands regularly, especially after eating and using the toilet.
  • Avoid doing free sex behavior .
  • Do not change partners in sexual intercourse.
  • Use personal protective equipment ( PPE ) when working as a medical worker.
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