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What Is Cholestasis?
Written by Medicover Team and Medically Reviewed by Dr Dipak Ahire , Gastroenterologists Medical
Cholestasis is a condition where the normal flow of bile from the liver slows down or stops. When this flow is blocked, bile builds up in the liver and can leak into the bloodstream.
This condition affects several parts of the digestive system, including the liver, bile ducts, gallbladder, pancreas, and intestines.
If not treated early, cholestasis can lead to liver inflammation, problems with nutrient absorption, and long-term liver damage.
How Does Cholestasis Affect the Body?
Bile plays a key role in digestion and waste removal. In cholestasis, the blocked flow of bile causes it to accumulate in the liver. Over time, this buildup can cause:
- Inflammation of the liver
- Damage to liver cells
- A buildup of bile acids in the blood
- Symptoms such as fatigue, skin itching, and digestive issues
If cholestasis continues without treatment, it may lead to liver scarring (cirrhosis), permanent liver damage, or even liver failure.
It can also affect how your body absorbs essential fat-soluble vitamins (A, D, E, and K), leading to additional health problems.
What are the Symptoms and Warning Signs of Cholestasis?
One of the most common and distressing symptoms of cholestasis is intense itching, also known as pruritus. This itching often worsens at night and usually starts on the hands and feet before spreading.
In some cases, cholestasis itching can lead to skin damage or even a cholestasis rash due to constant scratching.
Common Symptoms of Cholestasis
- Yellowing of the skin and eyes (jaundice)
- Dark-colored urine
- Pale or clay-colored stools
- Constant tiredness or weakness
- Nausea or an upset stomach
- Pain in the upper right side of the abdomen
These symptoms are often the result of bile backing up into the bloodstream and the liver.
Severe Symptoms of Cholestasis
- Severe itchiness, particularly at night, without a rash
- Malabsorption of fat-soluble vitamins (A, D, E, and K)
- Bleeding or easy bruising (due to deficiency of vitamin K)
- Unexplained weight loss or weight gain (in children)
- Signs and symptoms of liver damage, including swelling in the legs or belly
What is Cholestasis of Pregnancy?
Cholestasis may also occur in pregnancy, generally in the third trimester. This is also known as Intrahepatic Cholestasis of Pregnancy (ICP).
It's related to hormonal changes that cause bile to flow more sluggishly from the liver.
Symptoms During Pregnancy
- Severe itching, especially on the palms of the hands and soles of the feet
- Dark urine
- Pale stools
- Jaundice (in rare cases)
ICP can increase the risk of complications like preterm birth, fetal distress, or even stillbirth. If you're pregnant and notice these symptoms, it's important to speak to your doctor immediately.
What Are the Different Types and Causes of Cholestasis?
Cholestasis is a condition where the flow of bile from the liver slows down or stops. This can happen either inside the liver or outside of it. Based on where the blockage or disruption occurs, cholestasis is classified into two main types:
Intrahepatic Cholestasis
This type occurs within the liver. It happens when the liver cells or the small bile ducts inside the liver are affected.
Common causes include:
- Viral infections like Hepatitis B, Hepatitis C, CMV, or HIV
- Chronic liver diseases, such as alcoholic liver disease or non-alcoholic fatty liver disease (NAFLD)
- Autoimmune conditions, including primary biliary cholangitis and primary sclerosing cholangitis
- Certain medications, including antibiotics, steroids, and oral contraceptives
- Hormonal changes during pregnancy, also known as intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis can develop gradually and may show signs like fatigue, itchy skin, and yellowing of the eyes or skin.
Extrahepatic Cholestasis
This type occurs outside the liver, usually due to a blockage in the larger bile ducts that carry bile to the small intestine.
Common causes include:
- Gallstones blocking the bile ducts (choledocholithiasis)
- Pancreatic cancer or bile duct tumors
- Bile duct strictures (narrowing) due to past surgery or inflammation
- Chronic pancreatitis
- Pancreatic pseudocysts pressing on the bile ducts
Extrahepatic cholestasis often leads to more noticeable symptoms, such as dark urine, pale stools, and pain in the upper abdomen.
What Are the Common Causes and Risk Factors of Cholestasis?
Many health conditions, medications, or lifestyle factors can increase the risk of cholestasis. Understanding these causes helps in early diagnosis and better management.
Main causes of intrahepatic vs. Extrahepatic cholestasis
Understanding the difference in causes helps guide treatment and diagnosis:
| Intrahepatic Causes | Extrahepatic Causes |
|---|---|
| Hepatitis B, C | Gallstones |
| Alcohol-related disease | Bile duct tumors |
| NAFLD | Pancreatic cancer |
| Autoimmune diseases | Surgical injury |
| Drug-induced liver injury | Pancreatitis |
| Pregnancy hormones | Bile duct strictures |
Both types can lead to serious liver damage if not diagnosed and treated on time.
Cholestasis Risk Factors
Certain people are at a higher risk of developing cholestasis due to underlying health or genetic conditions.
Key risk factors include:
- Family history of liver or gallbladder disease
- Pregnancy (especially during the third trimester)
- Autoimmune disorders (e.g., lupus, PBC)
- Obesity and related conditions like fatty liver disease
- Long-term intravenous nutrition (TPN)
- Use of specific medications like estradiol or terbinafine
- History of gallstones or bile duct problems
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Get Second OpinionHow is Cholestasis Diagnosed?
Diagnosis of cholestasis is made by a careful combination of physical examination, medical history, blood tests, and imaging.
Diagnostic Tests We Use
Blood Tests
These tests help assess the liver's functioning. They measure:
- Bilirubin levels
- Liver enzymes like ALP (alkaline phosphatase) and GGT (gamma-glutamyl transferase)
- Bile acids and cholesterol
Ultrasound Imaging
This is usually the first imaging test done. It helps check for:
- Blocked bile ducts
- Gallstones
- Liver or gallbladder abnormalities
CT Scan or MRI
These are used when more detailed images of the liver and bile ducts are needed. They provide a clearer picture if the ultrasound is inconclusive.
HIDA Scan (Hepatobiliary Iminodiacetic Acid Scan)
This special scan follows the flow of bile through the liver and into the small intestine. It helps detect whether there are any blockages in the bile flow.
ERCP (Endoscopic Retrograde Cholangiopancreatography)
This is both a diagnostic and treatment tool. It uses a flexible tube and dye to see the bile and pancreatic ducts and allows the doctor to remove blockages or place stents if needed.
Liver Biopsy
A small sample of liver tissue is examined under a microscope. It helps detect:
- Scarring
- Inflammation
- Long-term liver damage
Our experienced team is committed to identifying the cause and severity of cholestasis accurately. With the right diagnosis, we can guide you toward the best treatment.
What are the Treatment Options for Cholestasis?
While there is no universal cholestasis cure, the treatment plan for cholestasis depends on whether the condition is acute (sudden), chronic (long-term), and whether it is intrahepatic (inside the liver) or extrahepatic (outside the liver, in bile ducts).
Treatment for Acute Causes
When cholestasis is caused by an infection, medication, or a sudden blockage, the treatment may include:
- Changing or stopping certain medicines if the condition is drug-induced
- Antibiotics or antiviral drugs to treat bacterial or viral infections
- ERCP to remove gallstones or relieve blockages
- Stenting to open narrowed bile ducts and restore proper bile flow
Treatment for Chronic Causes
In long-term cases of cholestasis, treatment focuses on managing symptoms and protecting the liver:
- Ursodeoxycholic acid (UDCA): Helps improve bile flow and reduce the harmful effects of bile salts
- Naltrexone: A medicine that helps control itching caused by bile salt buildup
- Cholestyramine: Binds bile acids in the intestines to ease itching and support fat digestion
- Fat-soluble vitamin supplements (A, D, E, K): Important when the liver is not absorbing these vitamins well
- Lifestyle changes: Avoiding alcohol, eating a low-fat diet, staying hydrated, and maintaining a healthy weight
Our goal is to treat both the root cause and the symptoms to improve liver function and prevent complications.
When to See a Doctor for Cholestasis?
Recognising the right time to seek medical attention is essential in managing cholestasis effectively. Early diagnosis and treatment can help prevent complications and improve long-term outcomes.
Consult a doctor if you experience any of the following
- Persistent itching, especially on hands and feet, with no visible rash
- Yellowing of the skin or eyes (jaundice)
- Dark-colored urine lasting more than two days
- Pale, greasy, or foul-smelling stools
- Ongoing fatigue or unexplained weight loss
- Itching or jaundice in the third trimester of pregnancy
You are at higher risk if you
- Are pregnant (especially in the later stages)
- Have a history of liver disease or hepatitis
- Are receiving long-term intravenous nutrition
- Take medications known to affect liver or bile flow
If you're in a high-risk group and experience any symptoms, it's important to contact your doctor as soon as possible.
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What is the Recovery Process After Cholestasis Treatment?
The recovery process depends on the cause of cholestasis and how early treatment begins. Our team supports you through each step, from diagnosis to recovery and follow-up care.
Post-Treatment Care Includes
- Regular check-ups with a hepatologist or gastroenterologist
- Blood tests to monitor liver function and bile flow
- Imaging tests (like ultrasound or MRCP) if needed
- Vitamin supplements, if fat-soluble vitamins (A, D, E, K) were deficient
- Monitoring for signs of liver damage or recurring symptoms
Lifestyle Recommendations to Support Recovery
- Follow a low-fat, liver-friendly diet with easily digestible meals
- Drink plenty of fluids to stay hydrated
- Avoid alcohol completely
- Do not take liver-harming medications unless prescribed
- Maintain a healthy weight through gentle physical activity
- Get enough rest and manage stress
Cholestasis Self-Care
In addition to medical treatment, cholestasis self-care plays a vital role in managing symptoms and improving quality of life.
Some helpful self-care tips include:
- Using cool compresses to reduce itching
- Wearing loose, breathable clothing
- Avoiding hot showers
- Taking doctor-recommended supplements (e.g., Vitamin K if prescribed)
- Eating a liver-friendly, low-fat diet
Long-Term Outlook
- Acute cholestasis often resolves with treatment and lifestyle adjustments
- Chronic cholestasis may require regular monitoring and long-term care
- In rare cases, if liver damage becomes severe, a liver transplant may be considered
Most people recover well when cholestasis is diagnosed early and managed properly. Long-term health depends on controlling underlying causes and maintaining a healthy lifestyle.
What Precautions Can Help Prevent Cholestasis?
While not all cases can be avoided, certain precautions may lower your risk, especially if you're prone to liver problems or are pregnant.
Prevention Tips
- Go for regular liver function tests if you're at risk
- Avoid alcohol and limit the use of unnecessary or over-the-counter medications
- Eat a balanced diet, low in fat and rich in fresh fruits and vegetables
- Monitor your liver health closely during pregnancy, especially in the third trimester
- Maintain a healthy weight and avoid crash dieting
- Manage underlying conditions like diabetes, thyroid disorders, or hepatitis
Taking these precautions can help protect your liver and reduce the chances of developing or worsening cholestasis.
Possible Complications of Cholestasis
If left untreated or not managed properly, cholestasis can lead to serious complications:
- Liver scarring (cirrhosis), which may affect liver function
- Deficiency of fat-soluble vitamins due to poor absorption
- Recurrent bile duct infections (cholangitis)
- Premature birth or stillbirth in pregnancy-related cholestasis
- Liver failure in long-standing or severe cases
Monitoring your symptoms and following up with your doctor can help prevent these outcomes.
Our Experience Treating Cholestasis
At Medicover, we understand that cholestasis, whether during pregnancy or due to chronic liver conditions, can be both physically uncomfortable and emotionally draining. That's why we're here to support you with care, clarity, and expert treatment.
Our team of hepatologists, gastroenterologists, and liver care specialists work together to provide a complete treatment plan. From accurate diagnosis to ongoing follow-up, we're with you at every step.
Early action, clear information, and compassionate care are key to better liver health. Our goal is to help you feel better, faster, so you can return to a more comfortable, healthier life.
