Cholestasis
Cholestasis refers to a marked reduction in bile flow through your biliary system (liver, gallbladder and bile ducts).
What is cholestasis?
One of your liver’s numerous jobs is to produce a fluid called bile, which is delivered to your digestive system through a network of bile ducts.
These bile ducts, along with organs (liver, gallbladder, pancreas and small intestines) form your biliary system. Its job is to drain waste products from the liver into the duodenum and to aid digestion with the controlled release of bile.
Cholestasis stops or slows the flow of bile through your biliary system. When bile can’t flow properly through the bile ducts, it:
- Gets clogged in your bile ducts and organs, causing irritation and interfering with normal function
- Leaks into your bloodstream with toxic effects.
Depending on its underlying cause, cholestasis can be a temporary problem or a long-term one.
Cholestasis symptoms
Cholestasis symptoms may include:
- Jaundice – your eyes and skin develop a yellowish tint due to bilirubin, a key component of the bile that is building up in your blood
- Darker pee – also due to a buildup of bilirubin
- Lighter poo – due to a lack of bilirubin where it is needed. Without bile to break down fats in your intestines, those fats are excreted in your poo, making it paler (it’s bilirubin that usually makes your poo brown), smellier and more floaty
- Itchy skin (pruritus) – caused by the buildup of bile salts in your blood which irritate your nerves and make your skin itch.
- Abdominal pain
- Nausea and vomiting
- Fatigue.
What causes cholestasis?
We divide cholestasis into two types:
- Intrahepatic cholestasis means the cause originates in your liver
- Extrahepatic cholestasis means the cause originates outside your liver.
Causes of intrahepatic cholestasis
- Chronic liver disease can scar your liver tissues (cirrhosis), including the bile ducts within your liver. That scarring narrows the bile ducts and restricts the flow of bile.
- A number of conditions affecting your liver including various types of chronic (ongoing) hepatitis or cholangitis
- Acute hepatitis due to alcohol poisoning, mononucleosis, HIV, cytomegalovirus, liver cancer, lymphoma, sepsis or a gallbladder infection
- Late pregnancy – high oestrogen levels can reduce bile secretions from your liver
- Total parenteral nutrition – IV feeding bypasses your digestive system. With no food in your small intestine, your liver might not realise it needs to keep delivering bile
- Some medications, including birth control pills, anabolic steroids, antibiotics, immunosuppressants, antidepressants, hormone replacement therapy and many other drugs.
Causes of extrahepatic cholestasis
- Biliary stricture – scarring and narrowing of your bile ducts due to surgery, injury, pancreatitis, cancer, cholangitis or biliary atresia
- Bile duct obstructions – due to gallstones, cysts or tumours.
Cholestasis in pregnancy
Because of the extra demands a developing baby places on your body, it is possible to develop cholestasis in pregnancy.
The exact cause of pregnancy cholestasis is unclear but it may involve an interplay between your:
- Pregnancy hormones
- Genetics
- Environment (it’s more common in winter, for some reason).
You’re at higher risk of developing cholestasis of pregnancy if you:
- Have had it before, e.g. in previous pregnancies
- Have a family history of the condition
- Have existing liver problems such as hepatitis C or gallstones
- Are carrying twins or triplets
- Are over 35.
Whatever may trigger it, the result is the same. Cholestasis reduces or stops bile flow. As a result, bile may build up in your liver and enter your bloodstream.
Symptoms of pregnancy cholestasis include:
- Intense itching – while there’s no rash, you may itch on your palms, feet or all over your body to such a degree that it’s hard to sleep
- Yellow skin or eyes (jaundice)
- Nausea
- Loss of appetite
- Oily, smelly poos.
Please see your doctor immediately if you develop these symptoms. If you have cholestasis of pregnancy, you’re more likely to develop other conditions like gestational diabetes or pre-eclampsia, so you need a higher level of care.
Cholestasis of pregnancy may cause serious complications affecting your baby, including:
- Premature birth
- Breathing problems – meconium may pass into the amniotic fluid and enter the baby’s lungs if the mother has cholestasis
- Stillbirth.
Your doctors may recommend:
- Medication to lower the bile levels in your blood
- Treatments to ease your itching
- Closer monitoring of your baby’s health in the womb
- Early delivery, around 37 weeks.
How do you diagnose cholestasis?
If your doctor suspects you may have cholestasis, they will usually order a blood test to look for elevated levels of blood salts, bilirubin, cholesterol and some liver enzymes.
If your results suggest a need for further investigation, your doctor may order imaging scans, an endoscopy (a procedure to look inside your digestive system with a small camera on a flexible tube) or a liver biopsy.
Treatment
Treatment of cholestasis depends on the underlying cause. It might involve:
- Changing medications
- Treating infections
- Removing physical obstructions in the bile ducts
- Inserting stents to open up narrow passageways
- Slowing the course of chronic liver disease with lifestyle changes such as avoiding alcohol, improving diet, and exercising more regularly
- Medications to improve bile production or reduce itching.
How Moonee Valley Specialist Centre can help
We understand that any liver condition is concerning. Our empathetic and caring team can provide assessments, diagnosis, and management for cholestasis. Dr Nathan Connelly is experienced in helping patients, focusing on providing holistic care to each person.
Please see your GP and ask for a referral.
*All information is general and is not intended to be a substitute for professional medical advice. Moonee Valley Specialist Centre can consult with you to confirm if a particular treatment or procedure is right for you. Any surgical or invasive procedure carries risks.
