What is Cholestasis and Cholestasis Diagnosis
Cholestasis is the slowing or stopping of bile flow. Biles are produced in the liver to help with digestion. It blocks up the body’s natural elimination system and prevents toxins from being removed easily by the kidneys.
Cholestasis can be temporary (acute) or permanent (chronic).
Acute cholestasis is more common in pregnancy.
It can have severe effects if not treated. The unborn baby will not get rid of the toxins exposed to, which can cause brain damage or heart problems.
Cholestasis in pregnancy:
It occurs when there is a problem with bile flow from the liver to the gallbladder and small intestine, rather than being caused by increased hormones like normal pregnancy jaundice. Typically this condition becomes evident after 20 weeks gestation.
Signs include itching (pruritus), dark urine, pale stools, nausea, vomiting, and right upper quadrant pain. Jaundice may also appear, but typically only in the second half of pregnancy, due to the build-up of red blood cells from the slowing of bile flow.
In moderate cases, a woman may feel generally unwell and have other symptoms, but it can cause stillbirth or early delivery in severe cases.
Treatment:
Treatment will depend on how severe your condition is. If you have mild cholestasis, no treatment may be needed as your symptoms should improve after birth.
In more severe cases, medication may be prescribed to help with itching and vomiting and drugs to reduce your liver function tests (LFTs) – high LFTs are what indicate cholestasis has occurred in the first place. You’ll need checkups to monitor your baby’s health.
If your baby shows signs of jaundice, phototherapy may treat the problem. Your specialist should also check for signs of infection that can occur with cholestasis during pregnancy or birth at least every four hours in the first 48 hours after delivery.
Antenatal appointments:
Your midwife will check you over at each antenatal appointment and test your urine, poo, and blood if necessary. This monitors how well both mum and baby are doing throughout pregnancy and labor.
There’s no specific test for cholestasis of pregnancy. Still, it will be considered a possible diagnosis if more than one risk factor is present on your medical history or during your midwife assessments, such as pre-eclampsia in pregnancy or high LFTs.
As there’s no one test to confirm cholestasis in pregnancy, your midwife will usually take a combination of information into account when making the diagnosis, including any symptoms you’re experiencing.
Postnatal appointments:- If you think you have cholestasis of pregnancy, you must see your doctor as soon as possible after giving birth. Your doctor may perform blood tests to check your kidneys are working correctly and advise whether further testing is needed.
Cholestasis of pregnancy is likely to be picked up on routine postnatal checks if present, which include urine samples and blood pressure measurements at six weeks postpartum, along with clinical assessment jaundice, pruritus, and maternal blood tests.
Prevention:
There is no way to prevent the cholestasis of pregnancy or its complications. However, there are steps you can take to reduce your risk if you have a high-risk pregnancy, such as pre-eclampsia. Before getting pregnant again, discuss options with your doctor so you can find a suitable choice for managing a risk condition. You should be offered a preconception care appointment at least three months before trying to conceive again.
This means being assessed by a midwife and having any possible issues identified – including cholestasis of pregnancy – early on in the pregnancy. In this way, it’s possible to identify problems earlier and give yourself greater peace of mind and give your baby the best start in life.
cholestasis causes:
Cholestasis is a rare disease that causes the liver’s bile ducts to become blocked. This blockage prevents the normal flow of bile from the liver and gallbladder, where it is made into the intestine, which causes a backup of bile, leading to cholestasis symptoms. In addition to affecting the liver, bile helps your digestive system break down fat. Without enough healthy bile, you can’t digest food properly, and your body might not absorb specific vitamins and minerals either.
Bile flows from the liver through tiny tubes called canaliculi before entering larger canals called ductules afferents or ducts before reaching smaller connecting tubules called interlobular connective tissue, which joins smaller bile ducts in the liver called intrahepatic biliary tree, which then enters both branches of hepatic ductules.
Cholestasis is caused by either blockage or spasm of any part within this long canal, resulting in stasis or bile backing into diseased parts, causing pain and swelling.
cholestasis diagnosis:
The diagnosis of cholestasis is based on your medical history, physical exam, and various tests such as:
Blood tests to assess liver function and rule out other causes of itching, such as diabetes. Imaging studies such as ultrasound or computerized tomography (CT) scans can both confirm cholestasis along with the degree of blockage and extent of disease.
A hepatobiliary iminodiacetic acid (HIDA) scan. This research study uses a radioactive tracer and a gamma camera to measure the flow of bile into the small intestine; endoscopic retrograde cholangiopancreatography (ERCP), in which an x-ray shows images of blockage.
cholestasis treatment:
Medical management may include using Ursodiol, a prescription drug that slows or stops bile flow from the liver by increasing bile secretion. If there is a blockage in the common bile duct, surgery is needed to remove this blockage and re-establish drainage.
This surgery most commonly involves using a scope with a camera at one end (endoscope) to open up these blocked areas called sphincterotomy. Inserting stents may be done if sphincterotomies are not successful at opening up channels to allow for proper drainage.
cholestasis prognosis:
Complications depend on how quickly treatment is sought but can include sepsis caused by bacteria leakage into the bloodstream if untreated resulting in extensive liver damage, gallstones, and pancreatitis. The prognosis is good with early diagnosis, and treatment can result in complete recovery without damage to the liver.
cholestasis prevention:
No cholestasis prevention is known. Early diagnosis and treatment of the underlying condition can prevent or minimize damage to the liver.
The American Liver Foundation provides more information on cholestasis and a list of resources for those living with liver disease and their loved ones.
cholestasis treatment:
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cholestasis prognosis:
The prognosis is good with early diagnosis, and treatment can result in complete recovery without damage to the liver.
cholestasis prevention:
No cholestasis prevention is known. Early diagnosis and treatment of the underlying condition can prevent or minimize damage to the liver.
cholestasis causes:
Cholestasis causes are related to elevated bile acid levels, which increase inflammatory cytokines that stimulate pain receptors within canaliculi causing them to dilate, resulting in fluid leakage into surrounding tissue, causing inflammation and pain.