Cholestasis is a disease of the liver wherein the flow of bile is obstructed or slow down which further leads to many problems in the functioning of the body such as trouble in the absorption of nutrients. Bile is a liquid produced by the liver which helps in the absorption of fat from the food. It also helps in getting rid of bilirubin, an orangish-yellow pigment that is produced on the breakdown of Red Blood Cells (RBCs).

When Cholestasis occurs, the functioning of the liver alters which may lead to the production of more bilirubin which makes your skin look yellowish along with itching. This condition is not gender-specific or age-specific and can happen to anyone. However rare, it also happens among newborns as well.

Types of Cholestasis

Cholestasis is of two types-

Intrahepatic cholestasis

Intrahepatic cholestasis is a type that originates within the liver and can be caused by a disease, infection, excessive drug use, genetic abnormalities, and hormonal effects on bile flow. Apart from this, pregnancy can also increase the risk for Intrahepatic cholestasis.

Extrahepatic cholestasis

Extrahepatic cholestasis is a type of Cholestasis that occurs outside the liver and is caused by physical obstruction or blockage in the bile ducts. These blockages may result from conditions like gallstones, cysts, and tumours that restrict the flow of bile. Apart from this, Pancreatitis (Inflammation of the pancreas) can also slow down the bile flow.

Symptoms of Cholestasis

The symptoms of both types of cholestasis are the same. However, these symptoms are not seen in everyone with cholestasis. Adults having chronic cholestasis often do not show symptoms and are usually symptom-free. The symptoms are-

• Jaundice (a disease in which the skin and the white of the eyes turns yellow)
• Dark urine
• Light-coloured and smelly stool
• Swollen or extended abdomen
• Slow weight gain
• Pain in the abdomen
• Fatigue
• Nausea
• Excessive itching 

Some rare symptoms may include-

• Stomach pain
• Muddy skin colour
• Loss of appetite
• Fever
• Tiredness

Causes of Cholestasis

The main cause of Cholestasis is the blockage of bile which can be caused by a number of factors. These factors are listed below-

Medicines-

The liver plays an important role in the metabolism of medicines. There are certain antibiotics, anabolic steroids, nonsteroidal anti-inflammatories, oral contraceptives, antiepileptic drugs, antifungal, antipsychotic, and antimicrobial drugs that are more difficult for the liver to metabolize and may prove to be toxic to the liver.

Diseases

• Certain diseases can cause inflammation of the bile ducts, leading to cholestasis. These include viral infections such as HIV, hepatitis, cytomegalovirus, and Epstein-Barr.
• Bacterial infections can also lead to Cholestasis.
• There are certain autoimmune diseases that cause the immune system to attack and damage the bile ducts.
• Genetic disorders, such as sickle cell disease may also cause Cholestasis.
• Liver and pancreatic cancer, as well as lymphomas, are also possible causes of Cholestasis.

Diagnosis and Screening process of Cholestasis

The diagnosis of Cholestasis can be done through a physical examination, blood tests, imaging tests or a liver biopsy.

Physical Checkup-

This is done to check if there is-

• Broken blood vessels under the skin.
• A swollen spleen or gallbladder.
• Pain or fluid in the belly.
• Right upper abdominal pain that sometimes extends to the right shoulder.

Blood tests-

A blood test is basically done to check the functioning and efficiency of the liver. In the case of Cholestasis, there are two enzymes that are usually high. These are-

• Alkaline phosphatase
• Gamma-glutamyl transpeptidase

Another blood test can be done to measure the bilirubin that can indicate the stage of cholestasis. However, blood tests cannot identify the cause of cholestasis.

Imaging tests-

Imaging tests are done to scan the organs that can help find a blockage or tumour. These tests may be-

• An ultrasound
• Computed tomography (CT) scan,
• Magnetic resonance imaging (MRI).

All these use sound frequencies, X-rays, or radio waves to get images of the organs. In the case of a blocked bile duct, there may be some other tests that need more detailed imaging tests.

Liver biopsy-

In this, a sample of liver tissue is collected to check the health of the liver.

Treatment of Cholestasis

The treatment of this disease depends on the cause of cholestasis-

• In the case of disease, the underlying cause is treated to get rid of Cholestasis.
• If there is a blockage in the bile duct due to problems like gallstones or a tumour, the doctor may remove it using a surgical procedure.
• Sometimes the blockage is also removed without surgery.

Ways to Prevent Cholestasis

Certain ways to prevent or reduce the risk of Cholestasis are-

• Stop the consumption of alcohol.
• Quit certain drugs.
• Take calcium, vitamin D, or vitamin K in optimum amounts.
• Take medications to lower bilirubin.
• Consume a good, healthy, and balanced diet.

Home Remedies for Cholestasis

Guar Gum-

Guar gum is a fibre obtained from the seed of the guar. It helps to stabilize the liver which proves to be useful in relieving the symptoms of cholestasis.

Activated Charcoal-

Several studies conducted on the role of activated charcoal in Cholestasis show that activated charcoal may be considered a good option for the treatment of intrahepatic cholestasis of pregnancy. It acts as a natural treatment to trap toxins and chemicals in the body and flushing them out before absorption by the body.  Activated charcoal carries a negative electric charge that attracts positively charged toxins.

Milk Thistle-

Milk thistle, a natural herb is commonly used as a detoxifier, especially for the liver. It helps to promote healthy digestive function by increasing the production of bile juice and reducing inflammation. Studies reveal that milk thistle is used and effective in curing various liver diseases which includes cholestasis.

Dandelion Root-

Dandelion root and its tea are natural remedies that are safe for cholestasis of pregnancy. It is a proven remedy to strengthen the liver. Dandelion roots are rich in vitamins and nutrients which acts as a detoxifier for the liver and keep it working properly. Dandelion also supports the digestive system by maintaining the flow of bile, promoting the absorption of minerals.