Cholestasis - Classification

Extrahepatic cholestasis

Developingwith mechanical obstruction of the bile ducts, usually outside the liver; however, obstruction by cholangiocarcinoma of the porta hepatis, which invades the main intrahepatic ducts, may also be included in this group. The most common cause of extrahepatic cholestasis is a stone in the common bile duct; other causes include cancer of the pancreas and ampulla of Vater, benign duct strictures, and cholangiocarcinoma. These diseases often cause acute cholestasis.

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Intrahepatic cholestasis

It develops in the absence of obstruction of the main bile ducts (according to cholangiography). The causes of cholestasis are drugs, cholestatic hepatitis, hormones, primary biliary cirrhosis, sepsis. Primary sclerosing cholangitis may be accompanied by the development of both extra- and intrahepatic cholestasis depending on the location of the lesion and the presence of strictures of the common bile duct. Rare causes of cholestasis are Byler's disease, benign recurrent cholestasis, lymphogranulomatosis (Hodgkin's disease) and amyloidosis. Intrahepatic cholestasis can be acute (e.g., due to drug exposure) or chronic (e.g., primary biliary cirrhosis, primary sclerosing cholangitis).

It is not always possible to differentiate between types of cholestasis based on clinical symptoms and biochemical parameters. It is extremely important to differentiate between extra- and intrahepatic cholestasis using a diagnostic algorithm.

Patients with acute and chronic cholestasis may experience pruritus, malabsorption of fats, and vitamin K deficiency. Chronic cholestasis may also be accompanied by hyperlipidemia and bone damage.