Cholestasis

OVERVIEW

Cholestasis refers to any condition in which the flow of bile from the liver slows or stops.

Source
WHAT CAUSES IT?

There can be various causes of cholestasis that can be categorized in the following fashion:

Causes within the liver:

Causes outside the liver (bile duct obstruction):

  • Stone in the bile duct
  • Choledochal cyst
  • Stricture of bile duct
  • Cancer of the bile duct
  • Pancreatic cancer
  • Acute pancreatitis
WHAT IS THE INTIAL PRESENTATION FOR THIS CONDITION?

Patient Issues/Chief Complaints:

  • Jaundice
  • Pruritus: caused by the retained bile acids

Detection On Medical Workup:

  • Elevated bilirubin: can be noted on a CMP
WHAT ARE IMPORTANT ELEMENTS OF THE MEDICAL HISTORY?

Risk Factors:

Pregnancy (intrahepatic cholestasis of pregnancy)

History Of Present Illness (HPI):

  • Pruritus: is typically worse at night or premenstrual. Located on the palms and soles of feet.
WHAT ARE IMPORTANT FEATURES OF THE PHYSICAL EXAM?

Dermatological Exam:

  • Signs of jaundice: scleral icterus, yellowed skin
  • Sings of scratching: excoriations may be present.
  • Xanthoma: these are signs of hyperlipidemia and can be present in this condition.
CLINICAL WORKUP: SERUM STUDIES

Complete Metabolic Panel:

  • Elevated bilirubin: direct usually is elevated
  • Elevated alkaline phosphatase levels: 

Serum Bile Salts:

  • These should be elevated as well.
CLINICAL WORKUP: IMAGING STUDIES

Imaging studies: the following imaging studies can be used to identify possible causes of cholestasis

  • Abodminla ultrasound (liver and bile ducts) can identify anatomical causes of an obstructive cholestasis (choledochal cyst, gallstones)
  • Abdominal CT scan can also identify anatomical causes of an obstructive cholestasis (choledochal cyst, gallstones)
  • HIDA scan can help differential between different causes of cholestasis
  • ERCP can be used to identify anatomical causes of an obstructive cholestasis (choledochal cyst, gallstones)
  • PTHC can also be used to identify anatomical causes of an obstructive cholestasis (choledochal cyst, gallstones)
HOW DO WE TREAT IT?

The exact treatment will vary upon the underlying cause of the cholestasis.

When treating the pruritus the following are used:

  • Cholestyramine
  • Rifampin
  • Naltrexone
  • Sertraline
  • Phenobarbital: only used if patients really are unable to sleep due to the itching.
ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

 

Page Updated: 01.23.2017