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Hepatic cholestasis is a condition that consists of symptoms caused by factors leading to cholestasis or liver impairment. The arrangement of the ducts and bile ducts resembles a tube system. Their main task is to lead bile from the liver and gall bladder. Through the Vater’s nipple (the common bile duct opening to the duodenum), it enters the gastrointestinal tract, where it is used to digest fats.
Intrahepatic cholestasis
What if there is an obstruction in the path of the bile flow? Cholestasis is such a situation. This term describes the phenomenon of pathological cholestasis. Bile, secreted by hepatocytes (liver cells), can be obstructed at two stages of its outflow: in the liver itself (intrahepatic cholestasis) or just behind the liver (extrahepatic cholestasis).
Intrahepatic cholestasis – causes
The causes of extrahepatic cholestasis may be:
• stone in the bile ducts,
• cancer of the Vater nipple or other tumors that cause pressure on the area (e.g. pancreatic tumors),
• narrowing of the extrahepatic bile ducts, e.g. due to inflammation,
• biliary cysts,
• biliary atresia.
However, the causes of intrahepatic cholestasis include:
• narrowing of the intrahepatic bile ducts,
• infectious diseases,
• alpha-1-antitrypsin deficiency (hereditary disease),
• condition after surgery,
• tumors,
• taking certain medications,
• pregnancy (gestational cholestasis).
Symptoms of intrahepatic cholestasis
Unable to enter the digestive tract, bile begins to accumulate in the liver or bile ducts. Over time, this causes an increase in pressure in the bile ducts, which can even damage the hepatocytes. It is like a flood of water where someone has built a dam on the road. Bile and its metabolites are being dumped backwards. Some components of bile build up in the skin causing itching. Additionally, there is jaundice – yellowing of the skin and visible mucous membranes (conjunctiva, oral mucosa). Since bile is deficient in the digestive tract, it becomes difficult to digest fats and fat-soluble vitamins (A, D, E, and K).
Diagnosis and treatment of intrahepatic cholestasis
If you develop jaundice, see your doctor (preferably a surgeon) as soon as possible. If this is not possible, an ambulance should be called. Jaundice in itself is not life threatening. However, it is necessary to establish the cause of its occurrence – it is possible only in hospital conditions.
Depending on the cause of intrahepatic cholestasis, the therapy involves either conservative (pharmacotherapy) or surgical treatment.
Text: lek. med. Matylda Mazur