Cholestasis

Causes

Appropriate Tests

 

Differentiation between intra- and extra-hepatic cholestasis is made by clinical assessment and, as appropriate, diagnostic imaging.

Significant cholestasis may exist without jaundice being apparent.

Aspartate aminotransferase, Alanine aminotransferase, Alkaline phosphatase, Gamma glutamyltransferase (AST/ALT ratio), Lactate dehydrogenase, Bilirubin; Prothrombin time, Full blood count.

Liver biopsy, (Fine needle aspiration biopsy), if appropriate.

Tumours

 

  • Hepatic metastases

 

  • Hepatocellular carcinoma

 

  • Cholangiocarcinoma

 

  • Pancreatic carcinoma

See under Pancreatic neoplasm.

  • Lymphoma (non-Hodgkin)

 

  • Hodgkin lymphoma

 

Gall stones

 

Primary sclerosing cholangitis

 

Post-operative stricture

 

Primary biliary cirrhosis

Mitochondrial Ab, Immunoglobulins G, A, M. Marked elevation of IgM is suggestive of primary biliary cirrhosis.

Cystic fibrosis

 

Helminth infection, including

Ova cysts parasites faeces. Identification of fluke found at operation.

  • Fasciola hepatica

Fasciola hepatica Ab are of value for establishing the diagnosis and for monitoring treatment.

  • Clonorchis sinensis

 

Biliary atresia

 

Cholestasis of pregnancy (oestrogen related)

 

Drug-induced cholestasis

 

  • Oestrogen

 

  • Phenothiazines

 

  • Flucloxacillin

 

  • Amoxycillin/Clavulanate

 

  • Anabolic steroids

 

  • Erythromycin estolate

 

Granulomatous Hepatitis

 

Idiopathic

 

Sarcoidosis

 

Infection, especially

 

  • Brucellosis

 

  • Tuberculosis

 

  • Q fever

 

Genetic cholestasis

 

  • Dubin Johnson syndrome

Liver biopsy. Porphyrins urine.

  • Rotor syndrome

Liver biopsy.

  • Bile acid synthetic defects

Bile acids - specialised laboratory.

Hepatocellular disease, especially 

Primary hepatocellular disorders often have a cholestatic component.

  • Hepatitis

 

Consequences

 

Jaundice

 

Pruritus

 

Biliary colic

 

Ascending cholangitis

Blood culture.

Malabsorption, especially

 

  • Vitamin K deficiency

 

  • Osteomalacia

 

Biliary cirrhosis