What is cholestasis?
Cholestasis is a liver disease. It occurs when the flow of bile from your liver is reduced or blocked. Bile is fluid produced by your liver that aids in the digestion of food, especially fats. When bile flow is altered, it can lead to a buildup of bilirubin. Bilirubin is a pigment produced by your liver and excreted from your body via bile.
There are two types of cholestasis: intrahepatic cholestasis and extrahepatic cholestasis. Intrahepatic cholestasis originates within the liver. It can be caused by:
- drug use
- genetic abnormalities
- hormonal effects on bile flow
Pregnancy can also increase your risk for this condition.
Extrahepatic cholestasis is caused by a physical barrier to the bile ducts. Blockages from things like gallstones, cysts, and tumors restrict the flow of bile.
Read on to learn more about this condition.
Both types of cholestasis result in the same symptoms:
- jaundice, which is a yellowing of your skin and the white of your eyes
- dark urine
- light-colored stool
- pain in your abdomen
- excessive itching
Not everyone with cholestasis has symptoms, and adults with chronic cholestasis are often symptom-free.
Causes of cholestasis
Bile blockage can be caused by a number of factors.
Your liver plays an important role in metabolizing medications. Some medications are more difficult for your liver to metabolize than others and may be toxic to your liver. These medications include:
- some antibiotics, such as amoxicillin (Amoxil, Moxatag) and minocycline (Minocin)
- anabolic steroids
- some nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen (Advil, Motrin IB)
- oral contraceptives
- certain antiepileptic drugs
- certain antifungal drugs
- some antipsychotic drugs
- certain antimicrobial drugs
You should always take medications as directed, and don’t stop taking medications your doctor has prescribed without talking with them first.
Certain diseases can cause scarring or inflammation to the bile ducts, leading to cholestasis. Conditions include:
- infections from viruses such as HIV, hepatitis, cytomegalovirus, and Epstein-Barr
- bacterial infections
- certain autoimmune diseases, such as primary biliary cirrhosis, which can cause your immune system to attack and damage the bile ducts
- genetic disorders, such as sickle cell disease
- certain cancers, such as liver and pancreatic cancer, as well as lymphomas
Cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy, also called obstetric cholestasis, is estimated to occur in 1 to 2 pregnancies per 1,000 in the United States. The most common symptom of obstetric cholestasis is itching without a rash. This is caused by the buildup of bile acids in the blood.
The itching generally occurs in the last trimester of pregnancy. It can also be accompanied by:
- pale stools
- dark urine
- abdominal pain
See your doctor if you have itching in pregnancy. Some over-the-counter medications, such as antihistamines or anti-itch creams containing cortisone, are generally ineffective for treating this condition and may harm your unborn baby. Instead, your doctor can prescribe drugs that help with the itchiness but won’t harm your baby.
Causes and risk factors
Cholestasis that occurs during pregnancy can be an inherited condition. If your mother or sister had this condition during pregnancy, you may have an increased risk for also developing obstetric cholestasis.
Pregnancy hormones may also cause this condition. That’s because they can affect your gallbladder function, allowing bile to build up and flow over into your bloodstream.
Women carrying multiples are at higher risk of obstetric cholestasis.
Is obstetric cholestasis dangerous?
- preterm delivery
- fetal distress
Most cases of obstetric cholestasis resolve after delivery. The condition can affect your health in the long term, however. In research published in the Journal of Hepatology, women who had cholestasis during pregnancy had a three times greater risk of liver cancer later in life than women who didn’t have cholestasis while pregnant. They also had increased risk of:
Your doctor will ask questions about your medical history. You’ll also have a physical exam. Blood tests may be ordered to test for liver enzymes that indicate cholestasis. If test results are abnormal, your doctor may order imaging tests like ultrasound or MRI. Your doctor may also perform a liver biopsy.
The first step to treating cholestasis is to treat the underlying cause. For example, if it’s determined that medication is causing the condition, your doctor may recommend a different drug. If an obstruction like gallstones or a tumor is causing the backup of bile, your doctor may recommend surgery.
In most cases, obstetric cholestasis resolves after delivery. Women who develop obstetric cholestasis should be monitored post-pregnancy.
Cholestasis can occur at any age, and in both males and females. Recovery depends on how severe the case was before it was first diagnosed. Another factor is the underlying cause of the disease and how well it can be managed. For example, gallstones can be removed, which essentially cures the disease. If the condition is caused by damage to your liver, recovery may be more difficult.
You can do a few things to reduce your risk for cholestasis:
- Get vaccinated for hepatitis.
- Don’t abuse alcohol.
- Avoid using recreational intravenous drugs.
See your doctor right away if you suspect cholestasis. Early treatment can improve your chances for a full recovery.