Cholestasis: Causes, Signs, and Why It Is Dangerous

The phrase "bile stasis" sounds as if bile simply got bored and stopped. In reality, it refers to cholestasis—a condition in which the flow of bile from the liver is slowed or blocked. Together we will sort out that this is not a death sentence, what causes it, and which symptoms to watch for.

What bile stasis is

Cholestasis is any condition in which the flow of bile from the liver is slowed or obstructed. Bile is produced in the liver and travels through ducts to the gallbladder and duodenum. If an obstacle or malfunction occurs somewhere along this pathway, bile enters the intestine less effectively. At the same time, mechanical blockage is not always present: in many cases of cholestasis, there is none.

What causes bile stasis

There are many causes, and they vary. Outside the liver, bile flow is impaired by stones in the common bile duct, narrowing of the duct, cysts and tumors of the ducts, pancreatitis, a tumor or pseudocyst of the pancreas, and pressure on the ducts from a nearby mass. Inside the liver—alcoholic liver disease, viral hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, liver tumors, serious infections, pregnancy. Some medications can also cause cholestasis—for example, certain antibiotics, hormonal drugs, and some cancer treatments.

Impaired bile outflow: mechanical and functional causes

Extrahepatic cholestasis is associated with impaired patency of the biliary tract: biliary atresia, choledochal cyst, other anomalies, choledocholithiasis, compression of the ducts, helminthic infestations, bile thickening syndrome, and biliary dyskinesia. The intrahepatic variant is associated with disorders of the synthesis of bile components and their entry into the bile canaliculi. Gallstones are common and often cause no symptoms until a stone blocks the duct.

How bile stasis manifests

Symptoms can range from minimal to pronounced. These include jaundice—yellowing of the skin and whites of the eyes, pale stools, dark beer-colored urine, skin itching, nausea or vomiting, pain in the upper right abdomen, a feeling of heaviness in the right upper quadrant, a bitter taste in the mouth, and constipation. If a stone blocks the duct, the pain may be severe and constant, last longer than 30 minutes and up to several hours, radiate to the back, and be accompanied by nausea and vomiting.

• Yellowing of the skin and whites of the eyes
• Pale stools and dark urine
• Persistent skin itching
• Pain or heaviness in the right upper quadrant
• Nausea, vomiting, bitter taste in the mouth

How impaired bile outflow is detected

The doctor evaluates the complaints and orders tests. Blood tests measure bilirubin and alkaline phosphatase, as well as other liver parameters. Imaging includes abdominal ultrasound, CT and MRI of the abdomen, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography—which also helps determine the cause. Sometimes a liver biopsy is needed. It is also important to consider that standard tests detect signs of cholestasis only when bile flow is slowed by at least 20 percent, so they cannot be considered early markers.

Possible complications and when to see a doctor

Complications depend on the cause. Diarrhea, impaired absorption of fats and fat-soluble vitamins, severe itching, bone weakness with prolonged cholestasis, and, if sepsis develops, multiple organ failure are possible. Stones can lead to inflammation of the gallbladder or pancreas, and to jaundice with itching, dark urine, and pale stools. You should see a doctor for persistent itching, yellowing of the skin or eyes, and other symptoms of cholestasis.

This condition by itself is not a reason to call an ambulance; 103 or 112—if abdominal pain is sudden and very severe, radiates to the back, and is accompanied by vomiting, the temperature is very high or the person has chills, or the skin or whites of the eyes have turned yellow.

This material is for reference: it helps you understand what to discuss with a doctor, but does not replace a specialist consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer