Cholestasis is a clinical condition resulting from disruption of bile flow from the liver. It can be classified as extra- or intra-hepatic.

Factors that cause cholestasis include obstruction of the large bile ducts (extrahepatic), small bile ducts, canals (canaliculi), or cells (hepatocytes) of the liver, e.g., neoplasms, lesions, toxins, or drugs.

In the absence of infection, cholestasis may be well tolerated for long periods of time. However, advanced cholestasis may cause symptoms of generalized malaise, weakness, easy fatigability, nausea, anorexia, and severe pruritus. Bone disease (hepatic osteodystrophy) and cholesterol deposition (xanthomos, xanthelosmos)are seen with chronic cholestasis.

Diagnostic tests to evaluate cholestasis usually begin with routine blood tests of liver enzymes and liver function to establish the extent of liver injury. Once liver disease has been established, noninvasive diagnostic imaging procedures, e.g., ultrasonography are performed. Ultrasound procedures determine if a large duct obstruction is present, the location and nature of obstructing lesions, and are helpful in visualizing gallstones and neoplasms in the liver. Ultrasound, computed tomography (CT) scans and magnetic resonance imaging (MRI) are used if further investigation of the nature of a lesion is warranted, e.g., when cancer is strongly suspected. Performing a direct percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) obtains the most precise information about biliary structure. These procedures are done when noninvasive methods are inconclusive. Ultrasound also allows the distinction between cholestasis with dilated bile ducts and cholestasis without duct dilatation.

General principles for treatment include: cure or control of underlying disorders, e.g., resection of an obstructive neoplasm or lesion, surgical bypass of obstructed areas, bile duct exploration, dilation of strictures, or removal of drugs that may be causing the condition. Drugs such as cholestyramine, rifampin (Rifadin) and phenobarbital (Luminal) may be given to help with pruritus.

In an attempt to compensate for prolonged obstruction, rapid and repeated reproduction of very small biliary ducts results. Also, if duct obstruction is not relieved, an increasing amount of fibrosis occurs around the portal tracts accompanied by atrophy of liver cells. Cirrhosis with regenerative nodules occurs after months to years of biliary obstruction, and may require hepatic transplantation (see Diagnostic Code: 7351 Liver transplant) that is associated with a 90%, 1-year survival rate under optimal circumstances.

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