Cholestasis Symptoms

Cholestasis is a medical condition in which the flow of bile from the liver is restricted or reduced. The bile is a yellowish-brown, alkaline digestive fluid secreted by the liver. The function of bile is to aid in the digestion of lipids and fats in the small intestine, by the enzyme pancreatic lipase, secreted by the pancreas. The bile also contains bilirubin, a toxic substance generated by the liver during the breakdown of red blood cells. Excess accumulation of bilirubin around body cells, leads to jaundice.

The bile secreted by the liver, flows to the duodenum of the intestine through the common bile duct. A blockage in bile duct prevents the flow of bile, and bile starts to accumulate in the liver. In due course, the bile spreads to the rest of the body cells, through the bloodstream. This condition is termed as cholestasis and may result in rupture of the hepatocytes or liver cells. Cholestasis can either occur inside the liver (intrahepatic cholestasis) or outside it (extrahepatic cholestasis). An in-depth analysis of the symptoms and the various causes responsible for it, will give us a better understanding of this pathological condition.

Causes of Cholestasis

The causes of intrahepatic cholestasis are different from the causes responsible for extrahepatic cholestasis. The causes of intrahepatic cholestasis include liver disease, lymphoma, pregnancy, cirrhosis, inflammation of lymph nodes, sepsis, tuberculosis and hepatitis. Extrahepatic cholestasis is a result of narrowing of the bile duct, and stones or tumors in the bile duct or the pancreas. Obstetric cholestasis is caused due to the effect of pregnancy hormones, especially progesterone, on the functioning of the gallbladder. The bile secreted by the liver, is stored in the gallbladder and if the flow of the bile is restricted or reduced, there is a rise in the concentration of toxic bile acids in the blood.

Symptoms of Cholestasis

Cholestasis can result in a wide variety of symptoms. Some of the symptoms are as follows.

• Itchiness
• Dark urine
• Nausea or vomiting
• Loss of appetite
• Abdominal pain
• Jaundice
• Xanthoma
• Reduced level of prothrombin in the blood
• Portal hypertension

Itchiness or pruritus is one the most common symptoms. It mostly manifests as itching feet at night. It is caused by the excess accumulation of bile salts. The extent of itchiness varies in patients suffering from cholestasis. This itching results in severe rashes and scratches in patients. Children with cholestasis are irritable and do not socialize easily.

Diagnostic Process

The diagnosis of cholestasis is conducted using one or more of the following procedures.

• Laboratory tests to determine the levels of bilirubin, concentration of bile salts, level of fat in the feces, and blood cholesterol levels.
• Ultrasonography, CT scan, MRI and other imaging techniques to determine the causes of cholestasis, such as gallbladder stones.
• In extreme cases, however, biopsy of the liver, is the only method to ascertain the underlying cause of cholestasis.

Though extremely rare, cholestasis may lead to complications like diarrhea, liver failure, osteoporosis and jaundice. Obstetric cholestasis may result in a stillborn baby.

Treatment Options

Cholestasis can be treated by treating its symptoms and causes. Medications are administered for the itchiness, high blood cholesterol levels, and high bilirubin and bile salt concentration. Since breakdown and assimilation of fat does not take place, essential fat-soluble vitamins (A, D and K) are orally administered. However, if the cause is a blockage in the bile duct, it is surgically removed. Doctors may also advise calcium and vitamin D supplements for strengthening of bones.

Special Cases of Cholestasis

In addition to the causes, symptoms and treatments for cholestasis discussed above, two special cases of cholestasis occurrence must be considered - obstetric cholestasis and drug-induced cholestasis. A detailed account of each, is given as under.

Obstetric Cholestasis
Obstetric cholestasis (OC) is a condition observed in women during pregnancy, usually after the second trimester i.e after the completion of six months. This condition is otherwise known as intrahepatic cholestasis of pregnancy (ICP). The symptoms of OC are the same as those of cholestasis as discussed above, with the exception of jaundice, which is very rarely seen in pregnant women with cholestasis. Sometimes, ICP may lead to a premature labor. Mild depression is also one of the cholestasis symptoms in pregnancy. Obstetric cholestasis is a rare condition but it is relatively common in women with liver problems and with family history of the condition. It is also common in women carrying twins or triplets. Also, women who have experienced symptoms of OC during their first pregnancy, are likely to have it in their subsequent pregnancies as well. OC symptoms usually recede after the birth of the baby. There is no treatment as such. However, doctors may prescribe certain creams and emollients to cope with the itchiness, if it's severe.

Drug-Induced Cholestasis
As the name indicates, drug-induced cholestasis results due to the intake of certain drugs, which restrict or reduce the flow of bile from the gallbladder to the intestine. If a particular drug is observed to be responsible for cholestasis, the doctor may prescribe an alternative. This condition may also turn fatal as extreme cases may lead to permanent liver damage.

This was all about the diagnosis and treatment of cholestasis symptoms. If you experience any or all of these symptoms, consult your doctor immediately for timely diagnosis and treatment.