kolestase

Kolestase is a condition in which bile flow from the liver is reduced or obstructed, resulting in the accumulation of bile components such as bile acids, bilirubin, and cholesterol in the liver and blood. It can be intrahepatic, caused by problems within the liver, or extrahepatic, due to obstruction of the bile ducts outside the liver.

Common causes include drug-induced cholestasis (for example, certain antibiotics and other medications), pregnancy-related cholestasis, biliary obstruction from gallstones or tumors, primary biliary cholangitis, primary sclerosing cholangitis, infections, and congenital disorders. The extent and duration of cholestasis influence prognosis.

Pathophysiology involves impaired secretion or flow of bile, leading to retention of bile acids that can damage hepatocytes and ductules, causing pruritus and jaundice. Laboratory features typically show a cholestatic pattern with elevated alkaline phosphatase and gamma-glutamyl transferase, elevated direct (conjugated) bilirubin, and often modest transaminase elevation. Imaging, including ultrasound and MRCP, helps identify obstruction; ERCP may be used therapeutically. Liver biopsy may be required to determine intrahepatic causes.

Treatment focuses on addressing the underlying cause and relieving obstruction when present. Ursodeoxycholic acid is commonly used for certain chronic cholestatic diseases. If obstruction is present, procedures such as ERCP with stone removal or stenting may be necessary. Symptomatic management for pruritus can include cholestyramine, rifampin, or other agents; nutritional support and vitamin supplementation may be needed due to fat-soluble vitamin deficiency.

Prognosis varies with cause and chronicity; chronic cholestasis can lead to fat-soluble vitamin deficiency, osteoporosis, cirrhosis, and liver failure if not controlled.