Cholestasis

Decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts

Aetiology

Obstructive cholestasis

  • Caused by a mechanical blockage in the duct system, most commonly due to a gallstone in the common bile duct
  • Other causes include bile duct strictures and malignancy

Metabolic cholestasis

  • Disturbances in bile formation that can occur because of genetic defects or acquired as a side effect of many medications

Clinical presentation

  • Jaundice
  • RUQ pain
  • Fat malabsorption (steatorrhoea, weight loss)

Investigations

Imaging

  • USS
  • MRCP and/or ERCP if further clarification needed

LFTs

  • Cholestatic - ALP > ALT/AST, ↑ GGT and bilirubin

Management

  • Treat underlying pathology
  • In the case of gallstone obstruction:
    • ERCP - endoscopic sphincterotomy and stone removal
    • Surgical exploration of CBD (open or laparoscopic)