Abstract
Cholestasis is a disorder affecting secretion and flow of bile. It can be categorised as either intrahepatic or extrahepatic.
The most common cause of acute intrahepatic cholestasis are drug-related complications or a cholestatic course of common hepatic diseases. Chronic intrahepatic cholestasis is in adul-thood most often caused by primary biliary cirrhosis, primary sclerosing cholangitis or a cholestatic course of cirrhosis of the liver.
Congenital cholestatic diseases caused by a disorder to the particular bile transmitters in liver cells are rare, but studying them has yielded valuable knowledge about causes of cholestasis in many common adulthood diseases. Extrahepatic cholestasis is caused by mechanic obstructions in the bile ducts (litiasis, tumours, benign stenosis).
The basic clinical symptoms of cholestasis are fatigue, pruritus and icterus. The laboratory correlates are elevated levels of alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (CCT) and conjugated bilirubin.
An isolated elevation of CCT levels does not in and of itself indicate cholestasis. A mechanical obstruction in the bile ducts always needs to be ruled out first.
Non-invasive methods such as ultrasound, endosonography and MR are currently being used to diagnose diseases of the bile ducts; ERCP is a therapeutic method. Intrahepatic cholestasis is treated with ursodeoxycholic acid, cholestyramine is used to affect pruritus.
Advanced cirrhosis of the liver caused by chronic cholestasis can lead to considerations of liver transplantation. A mechanical obstruction must be treated by removing the obstacle.