Biliary tract diseases

Biliary tract diseases

Cholestasis is a pathologic state of reduced bile formation or flow which can be hepatocellular (intrahepatic), where an impairment of bile formation occurs, or ductular (extrahepatic), where impedance to bile flow occurs after it is formed.

Intrahepatic causes of cholestasis include viral hepatitis, alcohol, primary biliary cirrhosis, drug toxicity, Hodgkin’s lymphoma and pregnancy. Extrahepatic causes include choledocholithiasis, carcinoma, and ascariasis of the biliary tree.

Clinical presentation

• Jaundice

• Dark urine

• Pale stools

• Generalized body itching (pruritus)

Investigations

• Laboratory evidence of elevated serum levels of:

  • Total bilirubin

  • Direct bilirubin

  • Alkaline phosphatase

  • Gamma-glutamyl transferase

  • Transaminases

AND

• Supporting radiological evidence of dilated intra or extra hepatic biliary radicles

Pharmacological treatment

Definitive treatment

• Identify and treat specific cause

Supportive treatment

• Cholestyramine (PO) 4–16 g/day

  
  

  OR

• Ursodeoxycholic acid (PO) 20–30 mg/kg/day

Note

• Surgical intervention is indicated for extra hepatic cholestasis.