Cholestasis: Bile Flow Obstruction, Symptoms, and Treatment

Cholestasis = impaired bile flow → retention of bilirubin, bile acids, cholesterol.

Clinical Features

• Jaundice (skin/sclera yellowing).
• Dark urine (bilirubinuria), pale stools (acholic).
• Pruritus (bile acid deposition in skin).
• Fatigue, nausea, RUQ pain.

Etiologies

• Intrahepatic: Drug‑induced, viral hepatitis, PBC, PSC, pregnancy (ICP), sepsis, TPN.
• Extrahepatic: Choledocholithiasis, pancreatic/biliary malignancy, strictures.

Management

• Ursodeoxycholic acid (UDCA) improves bile flow, reduces pruritus.
• Cholestyramine binds bile acids in gut.
• ERCP/surgery for obstructive causes.
• Delivery for intrahepatic cholestasis of pregnancy (ICP).
• Liver transplant for end‑stage disease.

Early diagnosis prevents cirrhosis, fat‑soluble vitamin deficiency, and severe pruritus.