What is the main cause of cholestasis?
Cholestasis has many causes. In general, two types of problems may be going on. It may be a problem with your liver that inhibits its ability to secrete bile into your bile ducts. (This causes intrahepatic cholestasis, bile stasis inside your liver.) Or it may be a problem in your bile ducts that’s physically restricting the flow of bile through the ducts. (This causes extrahepatic cholestasis, bile stasis in the ducts outside of your liver.)
What are the possible causes of extrahepatic cholestasis vs. intrahepatic cholestasis?
Causes affecting your liver (intrahepatic causes) include:
Chronic liver disease. Chronic liver disease that lasts a long time can cause scarring of the liver tissues (cirrhosis), including the intrahepatic bile ducts. Scarring causes them to narrow, which restricts the flow of bile. Specific diseases may also damage the cells that produce bile in more specific ways. Some of these diseases include:
- Chronic hepatitis B.
- Chronic hepatitis C.
- Autoimmune hepatitis.
- Alcohol-induced hepatitis.
- Nonalcoholic steatohepatitis.
- Primary biliary cholangitis.
- Primary sclerosing cholangitis.
- Progressive familiar intrahepatic cholestasis.
Acute hepatitis. Acute liver inflammation (from a recent, temporary condition) can cause your liver to swell, inhibiting bile flow. Various toxins and infections may also cause the cells that produce bile to malfunction in different ways. Acute causes of hepatitis include:
- Alcohol poisoning.
- Toxic hepatitis.
- Viral hepatitis.
- Mononucleosis.
- HIV.
- Cytomegalovirus (CMV).
- Liver cancer.
- Lymphoma.
- Sepsis.
- Gallbladder infection.
Pregnancy. Cholestasis of pregnancy (also called obstetric cholestasis) occurs in some people during the third trimester, when estrogen levels are at their highest. High estrogen inhibits bile secretion in your liver. Obstetric cholestasis goes away by itself after you’ve delivered your baby.
Total parenteral nutrition. Being fed through an IV in your vein bypasses your entire digestive system, including the hormonal signals that trigger your biliary system. If there’s no food in your small intestine that needs bile to help break it down, your liver might not get the message to keep delivering bile. This can cause bile to back up in your liver.
Medications. Certain medications can also cause bile stasis in your liver. If your liver is having trouble metabolizing these medications, they can have a toxic effect. Some of these medications include:
- Birth control pills.
- Anabolic steroids.
- Amoxicillin and other penicillin antibiotics.
- Azathioprine, an immunosuppressant.
- Imipramine, an antidepressant.
- Estradiol, a type of hormone replacement therapy.
- Cimetidine, used to treat stomach ulcers.
- Tolbutamide, used to treat type 2 diabetes.
- Terbinafine, an antifungal
- Certain antipsychotic drugs, including chlorpromazine and prochlorperazine.
Causes affecting your extrahepatic bile ducts include:
Biliary stricture. Chronic inflammation in your bile ducts can cause scarring and narrowing of the ducts, restricting bile flow. Causes of stricture include:
- Prior surgery or injury.
- Chronic pancreatitis.
- Pancreatic cancer.
- Bile duct cancer.
- Cholangitis.
- Biliary atresia.
Bile duct obstructions. Physical obstructions may affect your bile ducts from the inside or outside, including:
- Gallstones in your common bile duct (choledocholithiasis).
- Gallstones in your cystic duct or Hartmann’s pouch (Mirizzi syndrome).
- Pancreatic cysts and pseudocysts.
- Extrahepatic bile duct tumors.
What are the symptoms of cholestasis?
The most typical symptoms include:
- Jaundice. A yellow tint to your skin and in the whites of your eyes is usually one of the first signs that your liver isn’t functioning properly. Jaundice is caused by the buildup of bile in your blood. Specifically, the yellow comes from bilirubin, one of the ingredients in bile. Some bilirubin also comes out in your pee, which may give it a darker color.
- Light-colored poop. You may also notice poop changes due to the absence of bile in your intestines. When bile can’t flow to your intestines to help break down fats, these fats come out in your poop. Fatty stools are whitish or clay-colored. Their light color comes from the absence of bilirubin, which usually makes them brown. They may also float and may be extra smelly.
- Pruritus. Skin itching (pruritus) is another common symptom of cholestasis. Bile-related pruritus is caused by the buildup of bile salts in your blood. The bile salts (or bile acids) irritate nerves in your peripheral nervous system, causing itching. There’s no rash with this type of pruritus. Some people seem to be more sensitive to bile salts than others, and pruritus may be mild to severe. Some people itch more in their hands, feet, arms or legs, and others itch all over.
You may have other symptoms related to the cause of your cholestasis, such as:
