Cholestasis is any condition in which the flow of bile
from the liver is slowed or blocked.
Intrahepatic cholestasis; Extrahepatic cholestasis
Causes, incidence, and risk factors
There are many causes of cholestasis.
Extrahepatic cholestasis occurs outside the liver. It can be caused by:
Bile duct tumors
Narrowing of the bile duct (strictures)
Stones in the common bile duct
Pancreatic tumor or pseudocyst
Pressure on the bile ducts due to a nearby mass or tumor
Primary sclerosing cholangitis
Intrahepatic cholestasis occurs inside the liver. It can be caused by:
Certain medications can also cause cholestasis, including:
- Antibiotics such as ampicillin and other penicillins
- Anabolic steroids
- Birth control pills
- Clay-colored or white stools
- Dark urine
- Inability to digest certain foods
- Nausea or vomiting
- Pain in the right upper part of the abdomen
- Yellow skin or eyes
Signs and tests
Blood tests may show that you have too much bilirubin
and alkaline phosphatase
Imaging tests are used to diagnose this condition. Tests include:
- CT scan of the abdomen
- MRI of the abdomen
- Endoscopic retrograde cholangiopancreatography (ERCP) (can also determine cause)
- Ultrasound of the abdomen
The underlying cause of cholestasis must be treated.
How well a person does depends on the disease causing the condition. Stones in the common bile duct usually can be removed, curing the cholestasis.
Stents can be placed to open areas of the common bile duct that are narrowed or blocked by cancers.
Calling your health care provider
Call your health care provider if you have:
Get vaccinated for hepatitis A and B if you are at risk. Avoid intravenous drug use and needle sharing.
Zollner G, Trauner M. Mechanisms of cholestasis. Clinics in Liver Disease. 2008;12:1-26.
Afdhal NH. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 158.
David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc., and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California.