Cholestatic Liver Diseases

Overview

Cholestatic liver disease is the disorders of the liver due to obstruction of bile flow. This can happen on a cellular level in the hepatocytes, at the level of intrahepatic biliary ductules, or extrahepatic mechanical obstruction of bile ducts.

Signs and Symptoms

Yellowing of the sclera of the eyes and skin, Pruritus, Spider angiomas, Tea-coloured urine, Pale and foul-smelling stool, Ascites, Abdominal pain, Unintentional weight loss, Nausea and vomiting, Loss of appetite, Fever, Fatigue

Common Causes

Primary sclerosing cholangitis, Primary biliary cirrhosis, Drugs and toxin such as estrogens, cyclosporine, azathioprine, macrolide antibiotics and tricyclic antidepressants, Malignancy especially hepatocellular carcinoma or metastatic cancer, Sepsis, Hepatitis, Granulomatous liver disease, Intrahepatic cholestasis of pregnancy, Choledocholithiasis, Pancreatic carcinoma, Total parenteral nutrition, Post-liver transplantation

Risk Factors

People above the age of 40, Having an inflammatory bowel disease such as ulcerative colitis and Crohn's disease, Taking medications such as estrogens, cyclosporine, azathioprine, macrolide antibiotics and tricyclic antidepressants, Severely ill patients on total parenteral nutrition, People with hepatocellular carcinoma or metastatic cancer, People who had liver transplant, Alcohol abuse

Investigation Techniques

Medical history and detailed drug history, Physical examination, Blood tests such as full blood count, liver function tests, antimitochondrial antibody level, Ultrasound scan of the liver and biliary tree, Endoscopic retrograde cholangiopancreatography (ERCP), Magnetic resonance cholangiopancreatography (MRCP), Computed tomography (CT) scan of the liver and biliary tree, Liver biopsy

Treatment and Prevention

Medications such as ursodeoxycholic acid, cholestyramine, antibiotic rifampin, opioid antagonists, immunosuppressants, Calcium and vitamin D supplements, Stop offending medications and alcohol, Surgical resection of diseased liver, Radiofrequency ablation of tumour, Liver transplant, Treat underlying infection