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.



  • 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






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








Biliary colic


Ascending cholangitis

Blood culture.

Malabsorption, especially


  • Vitamin K deficiency


  • Osteomalacia


Biliary cirrhosis


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