Cholestasis

the stasis of bile due to impaired outflow

Cholestasis is a stasis of bile: its formation in the liver cells or its flow along the bile ducts is disrupted. The components of bile — bile acids and bilirubin — accumulate in the liver and the blood.

Biochemically, cholestasis shows up as a rise in alkaline phosphatase and GGT, and later of direct bilirubin. Clinically — skin itching, jaundice, dark urine and pale stool.

Intrahepatic and extrahepatic

Intrahepatic cholestasis involves the liver cells themselves and the small ducts: primary biliary cholangitis, primary sclerosing cholangitis, viral hepatitis, medications, cholestasis of pregnancy.

Extrahepatic cholestasis is a mechanical obstruction to bile flow: a stone in the common bile duct, a scar stricture, a tumor of the pancreas or the bile ducts.

Symptoms and consequences

Typical are skin itching (sometimes agonizing), jaundice, dark urine, pale stool and fatigue. With prolonged cholestasis, the absorption of fats and fat-soluble vitamins (A, D, E, K) is impaired, and xanthomas appear.

Diagnosis and treatment

First cholestasis is confirmed by blood tests, then the cause is sought using ultrasound, MRCP or ERCP. Treatment targets the cause: removing a stone or stricture, ursodeoxycholic acid, and separately — medications against itching.

Reference ranges

The "cholestatic" biochemical profile — which markers rise first.

Alkaline phosphatase (ALP)	elevated — the main marker of cholestasis
GGT	elevated, confirms the hepatic origin of ALP
Direct (conjugated) bilirubin	elevated in marked cholestasis
ALT/AST	normal or moderately elevated

Important: An isolated rise in ALP with a normal GGT more often has a bone rather than a hepatic origin.

Calculate using this marker

Calculators where Cholestasis is used directly:

R-Factor Shows what's driving the injury — cholestasis or liver-cell death Open

Frequently asked questions

How does cholestasis differ from cytolysis?

Cholestasis is a stasis of bile, in which ALP and GGT rise first. Cytolysis is the destruction of liver cells with a rise in ALT and AST. The two processes often occur together, and their ratio is assessed by the R-factor.

Why does the skin itch with cholestasis?

The itching is linked to the accumulation of bile acids and other pruritogens in the blood. It eases with treatment of the cause; in addition, special anti-itch medications are used.

Sources

info

This content is educational and does not replace consultation with a physician. Reference ranges may vary depending on the laboratory and method — rely on the ranges stated on your own test report.

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