More than a disease in itself, cholestasis is a condition associated with various diseases, linked by severe impairment of the flow of bile to the duodenum. In intrahepatic cholestasis the biliary obstruction is internal to the liver, while in the extrahepatic cholestasis the block is located outside the organ.
Liver, Bile and Gall bladder
Bile is a concentrate of organic compounds (both exogenous and endogenous), produced by the liver in quantities of about 6 dl per day.
Bile plays an essential role in the proper digestion of lipids introduced with food; it also buffers the acidity of the gastric chyme, stimulates the intestinal peristalsis and exerts an antiseptic action against the bacterial flora, inhibiting the putrefactive phenomena. The products deriving from the degradation of hemoglobin (bilirubin), toxic substances of pharmacological origin and others of an endogenous nature (thyroid hormones, estrogen, cholesterol, etc.) are also removed from the body through bile.
Causes
| EXTRAEPATICAL COLESTASI | INTRAEPATIC COLESTASIS |
Bile duct tumors cysts Stenosis of the bile ducts Calculations in the common hepatic duct pancreatitis Pancreatic tumors or pseudocysts Tumor masses in adjacent organs Primitive sclerosing cholangitis | Alcohol abuse liver disease Amyloidosis Bacterial abscess in the liver Lymphoma, primary or secondary liver tumors Pregnancy (obstetric cholestasis) Primary biliary cirrhosis Primitive sclerosing cholangitis Sarcoidosis Sepsis Tuberculosis Acute viral hepatitis Sjögren syndrome |
Numerous drugs, such as chlorpromazine, prochlorperazine, gold salts, nitrofurantoin, anabolic steroids, sulindac, cimetidine, erythromycin and estrogens (including oral contraceptives), can cause cholestasis and produce liver damage.
Symptoms
Clay-colored or white-colored stools; dark urine; digestive difficulties with steatorrhea (oily stools); skin itching; nausea or vomiting; liver pain (under the last ribs of the right side); yellowish coloring of the skin or ocular sclerae (jaundice). Symptoms such as abdominal pain, lack of appetite, splenomegaly (enlargement of the spleen), ascites, (accumulation of fluid in the abdominal cavity), fever, spider Naevi (capillary dilations that converge at a central point, assuming the typical spider appearance), and rapid weight loss may be signs of severe liver disease.
Biliary colic, due to the presence of calculi in the biliary tract, is characterized by a very violent pain that occurs in the upper part of the abdomen, in the center or more frequently to the right under the ribs; subsequently the pain extends posteriorly until it reaches the lower tip of the scapula.
Diagnosis
In the presence of cholestasis, blood tests can show high levels of total bilirubin, alkaline phosphatase, gamma-glutamyl transpeptidase (Gamma-GT) and bile acids.
Instrumental examinations, such as CT, ultrasound and abdominal magnetic resonance, are necessary to investigate the causes of the origin of cholestasis. An endoscopic retrograde cholangiopancreatography can be performed to highlight the health status of the bile ducts (thanks to a tube made to descend orally to reach the extrahepatic bile ducts; if necessary, this probe allows performing therapeutic operations such as the removal of stones or the restoration of the patency of the occluded canals).
Care and treatment
The therapeutic intervention depends on the causes that produced the cholestasis. Calculations can be removed with minimally invasive surgery or interventional diagnostic techniques. Stents can be applied at the narrowing points (stenosis) of the bile ducts, somewhat like in angioplasty. Colestyramine, taken orally, can help in resolving the annoying itchiness typically associated with cholestasis (alternatively, topical corticosteroid-based creams or ursodeoxycholic acid can be used for short periods). During the treatment of cholestasis it is important to avoid taking any harmful substance for the liver, such as alcohol, fried fats and some medicines.
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