Symptoms of intrahepatic cholestasis of pregnant women: generalized itching

Gall bladder cholestasis syndrome: causes, symptoms, treatment

Cholestasis – this is a condition where bile does not enter the duodenum, as a result of which bilirubin enters the bloodstream and accumulates in the blood. Usually, bilirubin binds in the liver with bile, passes through the bile ducts into the digestive tract and is thus excreted from the body. With cholestasis syndrome, this process is disrupted. It is worth knowing about the causes of the condition, diagnosis and how to treat cholestasis.

Causes of cholestasis

Cholestasis syndrome of the gallbladder is of two types: obstructive – in which bile does not pass through mechanical blockages of bile ducts, and metabolic – the cause of which is genetic defects or the side effect of some medicines.

Possible reasons for the development of cholestasis:

• pregnancy;
• taking birth control pills;
• taking some medicines (antibiotics, statins);
• biliary atresia and other pediatric liver diseases;
• biliary injury;
• congenital anomalies of the bile ducts;
• stones in the gall bladder;
• acute hepatitis;
• primary biliary cirrhosis;
• primary sclerosing cholangitis associated with inflammatory bowel diseases;
• use of anabolic steroids.

Depending on the reason that caused cholestasis, the following are distinguished:

1. Intrahepatic cholestasis developing at the level of hepatocytes or intrahepatic bile ducts. Causes of intrahepatic cholestasis – acute hepatitis, primary biliary cirrhosis, cirrhosis caused by hepatitis B or C, alcoholic liver disease, taking medications, pregnancy, metastases that have spread to the liver.
2. Heavy – occurs with narrowing of the bile ducts, stones in the bile ducts, tumors of the gallbladder, pancreatitis (inflammation of the pancreas).

Treatment of extrahepatic cholestasis with blockage of the bile ducts is only surgical.

Causes of cholestasis during pregnancy

This form of cholestasis is known as recurrent jaundice of pregnancy. During pregnancy, the function of the liver is disturbed, which leads to the development of intrahepatic cholestasis. Symptoms of intrahepatic cholestasis of pregnant women – generalized itching and jaundice. Sometimes a dark color of urine is observed. The first symptom – intense itching of the skin during cholestasis occurring in the second or third trimester. The condition completely resolves after childbirth, however, the tendency to relapse persists when taking oral contraceptives, as well as during subsequent pregnancies.

Indicators of biochemical blood analysis in cholestasis of pregnant women: the level of bilirubin does not reach 100 μmol/l (6 mg%), being 34-86 μmol/l (2.5 mg%). Alkaline phosphatase activity is significantly increased, while other biochemical indicators of liver function are close to normal. Clinical, biochemical and morphological changes usually normalize within 7-14 days after delivery.

The cause of cholestasis during pregnancy – increased sensitivity of the liver to hormonal changes. The disease is benign and does not require treatment. Cholestasis in pregnant women is associated with an increased risk of stillbirth, therefore, after making such a diagnosis, the condition of the fetus should be carefully monitored.

Signs of liver cholestasis in a child

Cholestasis and jaundice in newborns, as a rule, are noted in the first two weeks of the baby's life. Cholestasis is diagnosed by an increase in total and direct bilirubin. Diagnosis of chronic cholestasis includes determination of albumin, liver enzymes, fractionated bilirubin in blood serum, PV/AChT. After that, a diagnostic assessment of neonatal cholestasis is necessary.

Signs of liver cholestasis in a child – babies are jaundiced, there is an enlarged liver, dark urine and discolored stools. In neonatal cholestasis, the primary failure of bilirubin excretion leads to a decrease in the content of bile acids and their salts in the gastrointestinal tract, as a result of which the absorption of fats and fat-soluble vitamins (A, D, E, K) is impaired. This leads to vitamin deficiency and impaired growth.

Specific treatment depends on the cause of the pathology. Babies with suspected biliary atresia need diagnostic surgery with intraoperative cholangiography. If biliary atresia is confirmed, portoenterostomy (Kasai operation) is performed – it is the absolute method of choice for surgical treatment of biliary atresia. It is advisable to perform the operation in the first two months of life, because the prognosis will worsen in the future. Even with adequate therapy, many children develop cirrhosis and will need a liver transplant.

In the absence of indications for specific therapy, medical nutrition with supplements of vitamins A, D, E, K is recommended. For artificial feeding, mixtures rich in triglycerides are indicated, which are better absorbed with a deficiency of bile acids. Read more about the diet for hepatic cholestasis on our website Dobrobut.com.

The prognosis of neonatal cholestasis varies from benign to a progressive disease leading to liver cirrhosis. Atresia of the biliary tract and lack of timely treatment can cause liver failure and death before the age of one year.