Symptoms of cholestasis
The clinical signs of cholestasis are dominated by a jaundice (yellow color of the skin and integuments) associated with dark urine, discolored stool and one pruritus (itching).
In the event of extrahepatic cholestasis, hepatomegaly (increase in the volume of the liver detected on palpation of the abdomen), a large gallbladder and fever may be seen by the doctor during the physical examination.
Depending on the cause of the cholestasis, other non-specific clinical signs may be found (for example weight loss in cancer).
Laboratory tests of the blood show:
-a increased alkaline phosphatase which is the key element in the diagnosis of cholestasis.
-an increase in gamma-glutamyl transpeptidase (gGT). This increase is not specific for cholestasis and can be observed in all liver and biliary disorders (alcoholism for example)
-an increase in conjugated bilirubin, responsible for jaundice
-signs of vitamin A, D, E, K deficiency
-a decrease in prothrombin (PT) level linked to a decrease in factor V (coagulation protein) in hepatocellular insufficiency
To find out the cause of cholestasis, theAbdominal ultrasound is the first-line examination, showing dilation of the bile ducts in cases of extrahepatic cholestasis. In the case of intrahepatic cholestasis, abdominal ultrasound does not find dilation of the bile ducts.
As a second intention, the doctor may have to prescribe other radiological examinations:
– a cholangiopancreatography (x-ray of the bile ducts after using a contrast product)
— un scanner abdominal
-An MRI (Nuclear Magnetic Resonance Imaging) of the bile ducts
-an endoscopy
In the absence of an abnormality of the bile ducts demonstrated by the ultrasound, other examinations are performed to highlight the cause of the cholestasis:
-specialized blood tests (search for anti-mitochondrial antibodies and antinuclear antibodies) may be indicative of primary biliary cirrhosis.
– a search for viruses responsible for hepatitis can be carried out
If these various examinations have not revealed a specific cause, a liver biopsy may be necessary.
Special case: cholestasis of pregnancy. -It occurs most often during the third trimester of pregnancy and is a danger to the fetus. -The mechanism is linked to an accumulation of bile acids in the maternal blood; these excess bile acids can cross the placenta and collect in the bloodstream of the fetus. -Less than 1% of pregnancies are affected by cholestasis of pregnancy [1] -The risk of cholestasis of pregnancy is increased in the event of twin pregnancy, personal or family history of cholestasis of pregnancy -It manifests itself by pruritus (severe itching) preferentially in the palms of the hands and the soles of the feet, but the whole body may be concerned. In the absence of medical care, jaundice may appear -The diagnosis is confirmed by biological blood tests showing an increase in bile acids -The risk, small for the mother, can be serious for the fetus: fetal suffering and risk of premature delivery -Treatment with ursodeoxycholic acid reduces the increase in bile acids and pruritus -After childbirth, the pruritus gradually disappears and liver function returns to normal – Monitoring is necessary during a possible subsequent pregnancy. |