The cholestasia or cholestasis it is a disease that affects the liver. It can be defined as a decrease or blockage in bile flow due to impaired secretion by liver cells (hepatocytes), or obstruction of bile flow through intra- or extra-hepatic bile ducts..
Bile is a liquid produced by the liver that helps with the digestion of food, mainly fats. Not all substances usually excreted in the bile are retained to the same extent in various cholestatic disorders.
Demonstrable retention of various substances is necessary to establish a diagnosis of cholestasis. When the bile flow does not pass to the intestine, there is a retention of bilirubin, as well as bile acids and canalicular enzymes of the hepatocyte.
These are important signs of cholestasis, demonstrable with laboratory tests. When cholestasis is maintained, the accumulation of bile elements is toxic to the liver, and if it persists long enough, the end result is fibrotic atrophy of the liver, known as liver cirrhosis..
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There are two types of cholestasis: intrahepatic cholestasis and extrahepatic cholestasis.
Intrahepatic cholestasis occurs in the bile canaliculi within the liver and can have multiple causes..
These causes include a wide range of infections: from viral hepatitis to even parasite invasion of the bile ducts (clonorquis sinensis).
Genetic abnormalities inherent to metabolism are also an important cause, as well as the consumption of certain drugs, among other causes..
Extrahepatic cholestasis is caused by a physical barrier to the bile ducts. They can be generated by blockages of gallstones, cysts and tumors that restrict the flow of bile.
Cholestasis patients can present clinically in different ways, depending on the disease process. Some symptoms can be:
- Dark urine.
- Pain in the upper right part of the abdomen.
- Nausea or vomiting.
- Fatigue.
- Inability to digest certain foods.
- Clay-colored or white stools.
- Yellow skin or eyes.
- Excessive itching.
Another important physical finding in patients with cholestasia, especially infants, may be reduced height and low weight for height due to poor absorption of fat..
Not all people with cholestasia have symptoms, and adults with chronic cholestasia often do not have any symptoms..
One of the main causes in order of frequency of cholestasia is the development of stones in the gallbladder that migrate to the bile ducts, obstructing them..
There are multiple risk factors for gallbladder stones, such as female sex, obesity, history of several pregnancies, among others..
Some medications can be toxic or more difficult for the liver to metabolize, which plays an important role in metabolizing medications..
Others can promote the formation of gallstones which, as we discussed earlier, are an important factor to take into account. Some are:
- Antibiotics such as amoxicillin, ceftriaxone, and minocycline.
- Anabolic steroids.
- Oral contraceptives.
- Some non-steroidal anti-inflammatory drugs, such as ibuprofen.
- Certain drugs (antiepileptic, antifungal, antipsychotic, antimicrobial).
Cholestasia can be caused by a number of diseases that can cause scarring or inflammation of the bile ducts, such as:
- Viruses such as HIV, hepatitis, cytomegalovirus, and Epstein-Barr.
- Autoimmune diseases, such as primary biliary cirrhosis, which can cause the immune system to attack and damage the bile ducts.
- Genetic disorders.
- Some types of cancers, such as liver and pancreatic cancer, as well as lymphomas.
- Alagille syndrome
It is also called intrahepatic cholestasis of pregnancy or obstetric cholestasis. It is a common obstetric pathology in the third trimester of pregnancy.
Cholestasis of pregnancy can bring possible complications. Due to the risk of complications, premature deliveries are often recommended.
Intense itching is the main symptom of cholestasis of pregnancy, although there is no rash. Most women feel itchy on the palms of the hands or the soles of the feet; many times the itching tends to intensify at night, complicating sleep.
This modality can also be accompanied by other common symptoms of cholestasia. It is known that there are some genetic, hormonal and environmental factors that can cause the pathology.
The hereditary factor is often the cause. If the mother or sister had this condition during pregnancy, it may mean an increased risk of developing obstetric cholestasis.
Pregnancy hormones can also cause this condition. This is because they can affect the function of the gallbladder, causing bile to build up in the organ. As a result, the bile salts eventually enter the bloodstream..
Changes in diet, especially in edible oils, seasonal or temporary variations can also be causes of the condition.
Having twins or more babies can increase the risk of obstetric cholestasis.
Most cases are not threatening to the mother, but can cause complications such as premature labor, fetal distress, or stillbirth..
In research published in the Journal of Hepatology, women who had cholestasis during pregnancy had a three times higher risk of liver cancer later in life than women who did not have cholestasis during pregnancy.
Much of the medical care for patients with cholestasis is specific to the causative disease.
For example, if a certain drug is found to be causing the condition, your doctor may recommend a different drug..
If an obstruction such as gallstones or a tumor is causing bile to build up, your doctor may recommend surgical intervention..
In chronic cholestasis, special care should be taken to prevent fat-soluble vitamin deficiencies, which are common complications in pediatric patients with chronic cholestasis. This is accomplished by administering fat-soluble vitamins and monitoring the response to therapy..
In most cases, obstetric cholestasis resolves after delivery, subjecting affected women to a medical check-up.
Prevention measures include getting vaccinated against hepatitis A and B if at risk, not using intravenous drugs, and not sharing needles.
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