Cholestasis: Symptoms, Causes, And Treatment

In medicine, cholestasis is the stagnation of bile in the bile ducts. In common parlance, cholestasis is therefore also called biliary stasis. In practice, a distinction is made between intrahepatic cholestasis and extrahepatic cholestasis.

Intrahepatic means within the liver. This means that in this form of cholestasis, the reason for a back-up of bile is located directly in the organ. Learn everything you need to know about cholestasis here.

Cholestasis: When The Bile Goes Crazy

Bile disorders are not rare diseases. Since the time of the ancient Greeks, bile (Greek cholé) has been regarded as a trigger for temperamental outbursts. Cholerics, for example, literally get bile up.

Yet this bodily juice plays an important role in our lives. If something is wrong with its production or outflow, our body gets into trouble. Bile is produced in the liver.

A healthy liver produces 600 to 800 ml of bile in a day. This bile primarily contains bile acids. One of its most important tasks is to extract fats from food.

This is because it is the only way the body can absorb the vitamins and nutrients that are vital to it. Bile acids ensure that the fat-soluble vitamins A, D, E and K are absorbed. Other components of bile are non-organic ions, cholesterol, enzymes and colorants such as bilirubin.

Bile passes from the bile ducts in the liver directly into the duodenum as food is absorbed. When digestion is at rest, the bile is located in the gallbladder directly next to the liver.

Enzymes and messengers ensure that the bile flows out of the gallbladder when needed. But bile also flows from here into the duodenum in a healthy person.

By the way, a person does not have any diseases that make him “overflow bile”. On the contrary. Severe complaints always occur when a healthy body suddenly produces far too little bile.

It is also dangerous for health if the correct outflow of bile is disturbed. If the bile does not flow out or if it pours into the bloodstream, then the person suffers from cholestasis and should consult a doctor.

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Causes Of Cholestasis

Causes of cholestasis can be many and varied. They are located inside but also outside the liver. An adult with jaundice, or icterus, has a drainage obstruction that lies outside his or her liver in about 40 percent of cases.

Not only that, but the older a person gets, the more likely they are to have a drainage obstruction outside their liver. In fact, the most common cause is an obstructed gallstone.

It forms in the gallbladder and travels from here. Sometimes it becomes lodged in one of the bile ducts. The consequences are first colic-like pain and later cholestasis.

Women Are A Risk Group

Women over the age of 40 are particularly frequently affected. You belong to this risk group if you are around 40 and still fertile, if you are slightly overweight and also have a very fair complexion. If you then show signs of gallbladder problems, you should consult a doctor quickly.

Side Effects Of Medications

The majority of intrahepatic cholestases are not caused by the bile ducts. In many diseases, the congestion takes place directly in the cells of the liver.

The most common reason for this is an actually undesirable reaction of the liver to drugs. Because there are very many medicines and food supplements, which are noticeable by side effect on the function of this organ.

Under Suspicion: Kratom

A preparation that could possibly trigger a bile stasis is Kratom. This is a plant from Southeast Asia. It is known for a psychoactive, mood-lifting and healing and effect.

Kratom is the name given to the crushed or powdered leaves of the kratom tree. Kratom is also known as Krton, Mambog, Biak, or Mitragyne, The Kratom tree itself comes from the same plant family as the coffee plant.

Known was the healing effect of the Kratom already in the 19th century. In folk medicine, for example, kratom has a reputation for inhibiting inflammation. It is also said to reduce fever and also help with severe diarrhea. However, one of the most important effects of kratom is the reliable relief of pain.

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Research has shown that kratom reduces the feeling of pain by 13 times compared to morphine. Thus Kratom already belongs into the range of a medicament. In Germany, it is nevertheless freely marketable.

However, you should be careful when using it. The drug is suspected of having a direct effect on the function of the liver. Should you take Kratom and get complaints with the gall bladder, a visit to the doctor is therefore strongly recommended.

Typical Symptoms: This Is What Happens In The Body During Cholestasis

A bile stasis shows itself with four typical symptoms: jaundice, dark urine, pale stool as well as a strong itching. Not all symptoms are always equally pronounced. If you show any of these symptoms, you should seek the advice of a physician.

Jaundice (Icterus). In addition to bile acids, bile fluid also contains a wide variety of bile pigments. One of these pigments is the already mentioned bilirubin. Like the other substances in a healthy body, it is excreted via the bile, the liver, and the intestines.

However, if the bile accumulates, the bilirubin also migrates into the bloodstream and is excreted from the body via the kidneys instead. Excess bilirubin is deposited in the eyeball, skin, as well as organs, turning them a yellowish color.

Dark urine. Bilirubin is also responsible for the dark brown color of urine. As a result of the disease, the bilirubin is in the blood and travels from there through the kidneys to be excreted in the urine. Dark bilirubin colors the urine brightly.

Light-colored stools. In normal cases, bile acid ensures that fat is broken down in the intestines. In the case of bile stasis, however, this fluid does not flow into the intestine as it normally would. This causes a deficiency in the breakdown of fat and discolors stool. Instead, it becomes pale and light.

The itch. In bile stasis, bile acids are deposited in the blood and skin This activates various hormones in the tissues and causes mild inflammation of the skin. It itches, there is constant scratching and, as a result, damage to the skin.

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How The Doctor Recognizes Cholestasis

The signs of cholestasis are, of course, the symptoms already described. However, to really diagnose cholestasis with certainty, a doctor must additionally rely on scientific and medical methods and instruments. This is because jaundice is not a sure sign of biliary congestion in every case.

Meulengracht’s disease, for example, also triggers the eyes to turn yellowish. Meulengracht’s disease is a congenital and rather harmless metabolic disorder in which a certain enzyme is not sufficiently active.

As a result, the red pigment in the blood is not broken down properly. The eyes turn yellow, along with headaches and fatigue.

These include:

  • Blood test in the laboratory.
  • Ultrasound examination (sonography) of the organs.
  • Endoscopy of the bile ducts, among others.
  • X-ray examination with contrast media.

The doctor checks whether the causes of cholestasis are in the liver itself or outside. The blood test shows him how pronounced the bile stasis already is. Both liver values and the amount of bilirubin in the blood play a role.

With the help of an ultrasound, the physician can see, for example, whether the bile ducts are dilated. This would be a sign of gallstones, which obstruct the outflow of bile.

Successful Treatment Of Biliary Obstruction

The therapy the doctor uses to treat a biliary obstruction depends on many factors. For example, it is important to know whether the causes lie within the liver (intrahepatic cholestasis) or whether it is due to external influences (extrahepatic (cholestasis).

In the case of intrahepatic cholestasis, the physician must treat the underlying disease. For example, if the cholestasis is caused by cirrhosis of the liver, liver transplantation is an option. If medications are the cause, they must be discontinued.

In the case of extrahepatic cholestasis, the physician must remove the obstacles to the outflow of bile. For example, the physician removes gallstones or dilates the bile ducts.

There are also a number of additional forms of treatment. If the bile stasis has lasted for a very long time, the patient suffers, among other things, from a dangerous deficiency of vitamins and other vital elements, such as:

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Especially the deficiency of calcium must be counteracted. Because it can lead to diseases in the bone structure. Vitamin deficiencies and deficiencies in trace elements are treated by the doctor by administering appropriate preparations.

A Special Form Of Bile Stasis: Pregnancy Cholestasis

Pregnancy cholestasis, also called pregnancy jaundice, is an intrahepatic cholestasis. That is, its causes lie within the liver.

It occurs about once or twice per 1000 pregnancies, making it relatively rare. In most cases, the liver disease occurs at a late stage of pregnancy. If it begins earlier than in the last three to four months, both the course and the chances of recovery are more difficult.

Many experts see genetic connections as the cause of pregnancy cholestasis. However, this disease can also occur without familial causes. Nevertheless, the attending physician first asks about familial predisposition.

If symptoms occur, he must make sure that it is not hepatitis C, gallstones or an acute fatty liver of pregnancy.

Rapid Treatment Saves Mother And Child

Pregnancy cholestasis absolutely must be treated. This is because it impairs the function of the liver and can be dangerous for the unborn child. Bile stasis, for example, leads to premature labor and, in the worst case, stillbirth. After birth, there is a high risk of postpartum hemorrhage in the mother. The reason is vitamin K deficiency.

Vital: Recognizing The Disease

The most important sign of pregnancy cholestasis is severe local itching. It starts on the palms of the hands and the soles of the feet, moves over the abdomen, and then spreads over the entire body. On the other hand, yellow skin and a yellow eyeball are rare.

Attention: during pregnancy, mild itching is not so rare. If the itching is very severe and you are unsure, you should inform your gynecologist. With a blood test, he will clarify the causes and initiate the right steps.

The most effective therapy is the induction of childbirth from around the 37th week of gestation. This is because after delivery, pregnancy cholestasis disappears on its own. In later pregnancies, however, this condition can reoccur. If you are affected, you should always have your liver values monitored.

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