What Is Cholestasis?

Cholestasis Overview

Cholestasis causes a buildup of bile and bilirubin in your bloodstream.
Cholestasis causes a buildup of bile and bilirubin in your bloodstream.

You can get cholestasis when your bile doesn’t flow the right way. Bile is a fluid your liver makes to help you digest fat from food. It also helps you get rid of bilirubin. That’s an orange-yellow pigment your body makes when your red blood cells break down. Cholestasis causes bile and bilirubin to build up in your bloodstream. That can make your skin yellow and itchy

You can get cholestasis at any age. It’s rare, but it even happens in newborns. Your genes, pregnancy, medication, or certain diseases can make it more likely. Some causes of cholestasis are easy to treat. Others may be more serious. Talk to your doctor right away about your symptoms so you can get the right care. 

Here’s more information that can help you understand how you might get cholestasis. It can also help you work with your doctor to treat it.

What Causes Cholestasis?

You can get cholestasis in two ways. If the problem starts inside your liver, it’s called intrahepatic cholestasis. If the problem starts outside your liver, it’s called extrahepatic cholestasis. 

Causes for intrahepatic cholestasis include: 

  • Illness: You may get cholestasis if you have a disease or infection that hurts your cells such as:
  • Medication: Some drugs can affect how your liver works. That may include medicines like: 
    • Antibiotics (such as the combination medicine amoxicillin and clavulanate) 
    • Antifungals
    • Antipsychotics or antidepressants 
    • Anti-inflammatories
    • Anti-thyroid 
    • Oral birth control
    • Drugs that suppress your immune system

You can also get cholestasis if you get parenteral nutrition. That’s nutrition your body gets through some means other than your intestines. For example you might be fed through a vein.

Causes of extrahepatic cholestasis include: 

  • Bile duct problems: Gallstones, cysts, or tumors can clog your bile ducts. Some diseases can narrow them. Primary biliary cholangitis, an ongoing disease, may scar or destroy bile ducts. Newborns can get a blocked or scarred duct. This is what doctors call biliary atresia.
  • Pancreatitis: Inflammation of your pancreas can slow your bile flow.

Cholestasis of Pregnancy

You make more of the hormone estrogen when you’re pregnant. This can slow or stop your bile flow. You may get intrahepatic cholestasis of pregnancy (ICP). It’s also called obstetric cholestasis. About 1 or 2 out of 1,000 pregnant women will get it. You can’t prevent ICP. But your doctor can treat it. 

You may have a higher chance of cholestasis in pregnancy if you: 

  • Carry more than one baby
  • Have a mother or sister who had cholestasis or ICP 
  • Already have liver damage
  • Have chronic hepatitis C
  • Had in vitro fertilization (IVF) treatment
  • Are Scandinavian, Indian, Pakistani, or Chilean  

You are more likely to get ICP in your second or third trimester. You may start off with itchy hands and feet. It may get worse at night. You may get yellow skin and eyes or dark pee. Tell your doctor about your symptoms. 

For your baby, ICP can increase the chances of: 

ICP usually goes away 4 to 6 weeks after your baby is born. But it may happen the next time you’re pregnant or if you use oral birth control.

Cholestasis Symptoms

You’ll have the same signs whether the problem starts inside or outside of your liver. 

Typical symptoms include: 

  • Itching
  • Yellow skin or eyes (jaundice
  • Dark pee
  • Light-colored poop
  • Poop that smells especially bad

You may also have:

Babies who get cholestasis may show signs of jaundice 3 to 6 weeks after they’re born. 

If your cholestasis goes untreated, you may have trouble absorbing nutrients. You may not get enough calcium and vitamin D. This can weaken your bones. You may bleed more if you get extremely low in vitamin K. You may lose weight. Children who have it may not gain weight easily.

Cholestasis Diagnosis

Your doctor will ask about your health history. She’ll want to know how long you’ve had your symptoms and if you’re taking any medication. Tell the doctor if you drink a lot of alcohol

You will also have a physical exam. The doctor might check to see if you have: 

  • Broken blood vessels under your skin
  • A swollen spleen or gallbladder 
  • Fluid in your belly
  • Belly pain
  • Right upper abdominal pain that sometimes radiates to the right shoulder

You may also need: 

  • Blood tests: These can show how well your liver works. There are two enzymes that are usually high if you have cholestasis. They are alkaline phosphatase and gamma-glutamyl transpeptidase. Your doctor will also measure your bilirubin. This can show how serious your cholestasis is. But blood tests won’t tell doctors the cause of your cholestasis. 
  • Imaging tests: Your doctor may want a scan of your organs. This can help find a blockage or tumor. You may need an ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI). These tests use sound, X-rays, or radio waves to create pictures of your organs. If you have a blocked bile duct, you may need more detailed imaging tests. 
  • Liver biopsy: Your doctor may take a sample of your liver tissue. This will reveal more about the health of your liver.

Cholestasis Treatment

Your care will depend on the cause of your cholestasis. You’ll need to treat any disease or infection if you have one. You may need to switch to a different medicine. If there’s something blocking your bile duct, your doctor may remove it with or without surgery. You may need a stent. That’s a piece of metal or plastic that can keep the duct open. 

Your doctor can give you medicine to help you itch less while you get better. These drugs keep bile out of your skin.

You may also need to: 

  • Stop drinking alcohol
  • Quit certain drugs
  • Take calcium, vitamin D, or vitamin K
  • Take medications to lower bilirubin, a type of waste in the bloodstream
  • Change your diet
  • Have surgery
  • Get a liver transplant if other treatments don’t work

Cholestasis of Pregnancy Treatment

If you’re pregnant, your doctor may give you a drug called ursodeoxycholic acid. It can help your liver work better and lower the bile in your blood. If that doesn’t work, your doctor may want you to give birth early. To keep you and your baby safe, you may need to have your baby around 37 or 38 weeks. Your baby can breathe on her own by then. 

Newborns with cholestasis may need surgery and extra nutrients. They also may need a liver transplant at some point. 

Outlook After Cholestasis

You can get back to normal when your bile starts to flow the right way. You may need to change your medicine, have surgery, or get treatment for another disease. If you’re pregnant, your cholestasis will resolve when your baby is born. Some causes of cholestasis may need long-term dietary and medical treatment. 

References
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Stanford Children’s Hospital: “Cholestasis of Pregnancy.”

Mayo Clinic: “Bilirubin test.”

Merck Manual: “Cholestasis.”

Shah, R., John, S. Cholestatic Jaundice (Cholestasis, Cholestatic Hepatitis), StatPearls Publishing, 2019.

Boston Children’s Hospital: “Cholestasis.”

Canadian Journal of Gastroenterology and Hepatology: “New Insights in Genetic Cholestasis: From Molecular Mechanisms to Clinical Implications.”

Clinical Liver Disease: “Systemic Causes of Cholestasis.”

Hepatology Communications: “Drug-induced cholestasis.”

International Journal of Molecular Sciences: “Hepatotoxicity by Drugs: The Most Common Implicated Agents.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Primary Biliary Cholangitis,” “Biliary Atresia.”

Cleveland Clinic: “Cholestasis of Pregnancy.”

World Journal of Gastroenterology: “Atypical causes of cholestasis.”

Clinics in Liver Disease: “Overview of Chronic Cholestatic Conditions in Adults: Terminology and Definitions.”
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