Decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts

Aetiology

Obstructive cholestasis

• Caused by a mechanical blockage in the duct system, most commonly due to a gallstone in the common bile duct
• Other causes include bile duct strictures and malignancy

Metabolic cholestasis

• Disturbances in bile formation that can occur because of genetic defects or acquired as a side effect of many medications

Clinical features

• Jaundice
• RUQ pain
• Fat malabsorption (steatorrhoea, weight loss)

Investigations

• Imaging:
  • USS
  • MRCP and/or ERCP if further clarification needed
• LFTs: cholestatic - ALP > ALT/AST, ↑ GGT and bilirubin

Management

• Treat underlying pathology
• In the case of gallstone obstruction:
  • ERCP - endoscopic sphincterotomy and stone removal
  • Surgical exploration of CBD (open or laparoscopic)