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| | __NOTOC__ |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Cholestasis}} |
| | {{CMG}} |
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| {{CMG}} | | {{SK}} Cholestatic jaundice; conjugated hyperbilirubinaemia; obstruction of bile duct; obstructive jaundice; acholuria; biliary stasis |
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| {{Editor Help}}
| | ==[[Cholestasis overview|Overview]]== |
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| ==Overview== | | ==[[Cholestasis pathophysiology|Pathophysiology]]== |
| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Image = |
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| Caption = |
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| DiseasesDB = 9121 |
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| ICD10 = {{ICD10|K|71|0|k|70}}, {{ICD10|K|83|1|k|80}} |
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| ICD9 = {{ICD9|576.2}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = ped |
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| eMedicineTopic = 383 |
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| MeshID = D002779 |
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| }}
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| | ==[[Cholestasis causes|Causes]]== |
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| {{SI}}
| | ==[[Cholestasis differential diagnosis|Differentiating Cholestasis from other Diseases]]== |
| In [[medicine]], '''cholestasis''' is a condition where [[bile]] cannot flow from the [[liver]] to the [[duodenum]]. Bile formation is a secretory function of the liver. It begins in bile [[canaliculus|canaliculi]] that form between two adjacent surfaces of liver cells ([[hepatocyte]]s) similar to the terminal branches of a tree. The canaliculi join each other to form larger and larger structures, sometimes referred to as Canals of Hering, which themselves join to form small bile ductules that have an epithelial surface. The ductules join to form [[bile duct]]s that eventually form either the right main hepatic duct that drains the right lobe of the liver and the left main hepatic duct draining the left lobe of the liver. The two ducts join to form the [[common hepatic duct]], which in turn joins the [[cystic duct]] from the [[gall bladder]], to give the [[common bile duct]]. This duct then enters the duodenum at the [[ampulla of Vater]]. The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system such as can occur from a [[gallstone]] or [[malignant|malignancy]] and metabolic types of cholestasis which are disturbances in bile formation that can occur because of [[genetic disorder|genetic defects]] or acquired as a side effect of many medications.
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| ==Etiology==
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| * [[Gallstone]]s
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| * [[Abdominal mass]] (e.g. [[cancer]])
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| * [[Primary sclerosing cholangitis]], secondary to [[inflammatory bowel disease]]
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| * [[Primary biliary cirrhosis]], secondary to autoimmune disorders
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| * Congenital anomalies of the bilary tract
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| * Biliary [[Physical trauma|trauma]]
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| * Some drugs, (e.g. [[Flucloxacillin]] and [[Erythromycin]])
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| * In children, [[biliary atresia]] and other pediatric liver diseases
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| * [[Pregnancy]], referred to as [[Intrahepatic Cholestasis of Pregnancy]], or Obstetric Cholestasis
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| ==Histopathology== | | ==[[Cholestasis risk factors|Risk Factors]]== |
| Under a [[microscope]], the individual hepatocytes will have a brownish-green stippled appearance within the [[cytoplasm]], representing bile that cannot get out of the cell. Canalicular bile plugs between individual hepatocytes or within bile ducts may also be seen, representing bile that has been excreted from the hepatocytes but cannot go any further due to the obstruction. When these plugs occur within the bile duct, sufficient pressure (caused by bile accumulation) can cause them to rupture, spilling bile into the surrounding [[biological tissue|tissue]], causing hepatic [[necrosis]]. These areas are known as bile lakes, and are typically seen only with extra-hepatic obstruction.
| | ==[[Cholestasis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Symptoms== | | ==Diagnosis== |
| * Pale stools,
| | [[Cholestasis history and symptoms|History and Symptoms]] | [[Cholestasis physical examination|Physical Examination]] | [[Cholestasis laboratory findings|Laboratory findings]] | [[Cholestasis CT|CT]] | [[Cholestasis MRI|MRI]] | [[Cholestasis ultrasound|Ultrasound]] | [[Cholestasis other imaging findings|Other Imaging Findings]] | [[Cholestasis other diagnostic studies|Other Diagnostic Studies]] |
| * dark urine,
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| * itchiness ([[pruritus]]) and
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| * [[jaundice]].
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| [[Bile]] is secreted by the liver to aid in the [[digestion]] of [[fats]]. Drugs such as [[gold salts]],[[nitrofurantoin]], [[anabolic steroids]], chlorpromazine, prochlorperazine, sulindac, cimetidine, [[erythromycin]], can cause cholestasis and may result in damage to the [[liver]]. | | ==Treatment== |
| | [[Cholestasis medical therapy|Medical Therapy]] | [[Cholestasis surgery|Surgery]] | [[Cholestasis prevention|Prevention]] | [[Cholestasis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Cholestasis future or investigational therapies|Future or Investigational Therapies]] |
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| == Differential Diagnosis of Cholestasis == | | ==Case Studies== |
| * After liver transplantation
| | [[Cholestasis case study one|Case #1]] |
| * After ulcer surgery
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| * [[Alagille Syndrome]]
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| * [[Alcoholic Hepatitis]]
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| * [[Alpha-1 Antitrypsin Deficiency]]
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| * [[Amebiasis]]
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| * [[Amyloidosis]]
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| * Bile duct carcinoma
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| * Bile duct calculi
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| * Bile duct cysts
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| * [[Biliary atresia]]
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| * [[Budd-Chiari Syndrome]]
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| * [[Bylers Syndrome]]
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| * Carbonic anhydrase inhibitors
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| * [[Caroli's Syndrome]]
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| * Cholangiocellular carcinoma
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| * Cholecystectomy
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| * Choledochotomy with T-tube drainage
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| * Chronic active hepatitis
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| * [[Cryptosporidiosis]]
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| * [[Cystic Fibrosis]]
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| * Drugs
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| * [[Dubin-Johnson Syndrome]]
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| * Duodenal abscess
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| * [[Echinococcosis]]
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| * Familiar progressive cholestasis
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| * [[Hemochromatosis]]
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| * [[Hydatid cyst]]
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| * Idiopathic postoperative jaundice
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| * Idiopathic relapsing cholestasis
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| * Impaired bile acid synthesis
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| * Intermittent cholestasis
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| * Ischemia of other origin
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| * [[Leptospirosis]]
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| * [[Liver abscess]]
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| * [[Liver Cancer]]
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| * Liver cysts
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| * Liver metastases
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| * [[Lymphoma]]
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| * [[Mirizzi's Syndrome]]
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| * Neoplasm
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| * [[Pancreatic Cancer]]
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| * Pancreatic cyst
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| * [[Pancreatitis]]
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| * Pancreatoduodenectomy
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| * Papillary carcinoma
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| * Parasites
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| * Parasitosis
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| * Pericholedochal infection
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| * Postoperative
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| * [[Pregnancy]] cholestasis
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| * Primary and secondary [[sclerosing cholangitis]]
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| * [[Primary biliary cirrhosis]]
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| * [[Primary sclerosing cholangitis]]
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| * Rare congenital causes
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| * Relapsing cholangitis
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| * [[Reye's Syndrome]]
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| * [[Sarcoidosis]]
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| * [[Sepsis]]
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| * [[Sickle Cell Anemia]]
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| * Stenosis of the bile papilla
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| * Stricture
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| * Total parenteral nutrition
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| * Toxic, allergic
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| * [[Toxic Shock Syndrome]]
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| * [[Viral Hepatitis]]
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| * [[Wilson's Disease]]
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| * [[Zieve's Syndrome]]
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| ==See also== | | ==Related Chapters== |
| *[[Jaundice]] | | *[[Jaundice]] |
| *[[Liver function tests]] | | *[[Liver function tests]] |
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| *[[Intrahepatic Cholestasis of Pregnancy]] | | *[[Intrahepatic Cholestasis of Pregnancy]] |
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| ==External links==
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| *[http://www.nlm.nih.gov/medlineplus/ency/article/000218.htm Drug-induced cholestasis] - medlineplus.org
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| *[http://www.liverfamilies.net Liver Families] = pediatric liver support group
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| *[http://www.itchymoms.com/ Itchy Moms] - information about Obstetric Cholestasis / Cholestasis of Pregnancy
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| *[http://www.ocsupport.org.uk/ OC Support website] - OC Support website: information about Obstetric Cholestasis, research, support, shared experiences, discussion forum.
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| {{SIB}}
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| {{Gastroenterology}} | | {{Gastroenterology}} |
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Hepatology]] | | [[Category:Hepatology]] |
| | [[Category:Obstetrics]] |
| | [[Category:Disease]] |
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| [[pl:Cholestaza]] | | [[pl:Cholestaza]] |