Cholestasis

Question 1

Cholestasis is the impairment of _______________ and/or _______________, which may clinically present with fatigue, pruritus, dark urine, pale stools, an din its most overt form, jaundice and signs of fat soluble vitamin deficiencies

Answer 1

Formation

Bile flow

Question 2

What is the clinical presentation of cholestasis? (6)

Answer 2

1. Fatigue
2. Pruritus
3. Dark urine
4. Pale stools
5. Jaundice
6. Fat-soluble vitamin deficiencies

Question 3

What is the treatment of cholestatic pruritus?

Answer 3

First line:
- colestyramine

Second line:

• ursodeoxycholic acid
• rifampicin (unlicensed)
• sertraline (unlicensed)
• naltrexone (unlicensed)

Question 4

What is the mechanism of action of colestyramine?

Answer 4

Anion-exchange resin that is NOT absorbed by the GIT; relieves pruritus by forming an insoluble complex with bile acids in the intestines thereby reducing serum bile acid levels and reducing excess deposition of bile in the dermal tissues

Question 5

What is the mechanism of action of ursodeoxycholic acid?

Answer 5

A bile acid found in the bile of bears (ursidae) as a conjugate with taurine; used therapeutically, it prevents the synthesis and absorption of cholesterol and can lead to dissolution of gallstones

Question 6

__________________ is effective for treating pruritus associated with intrahepatic cholestasis of pregnancy

Answer 6

Ursodeoxycholic acid

Question 7

Intrahepatic cholestasis usually occurs in _____________ pregnancy and is associated with adverse fetal outcomes.

Answer 7

late

Question 8

Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis) is associated with increased risk of …? (5)

Answer 8

Premature birth, meconium stained amniotic fluid, respiratory distress, fetal distress, fetal demise

*treatment with ursodeoxycholic acid AND labor induction at 37-38 weeks (but may not be evidence-based)

Question 9

What are the symptoms of intrahepatic cholestasis of pregnancy (obstetric cholestasis)? (4)

Answer 9

• Pruritus (may be intense), typically worse on palms, soles and abdomen)
• clinically detectable jaundice in around 20% of patients
• dark urine, pale stools
• nausea, anorexia

+ raised bilirubin in > 90% of cases

Question 10

What causes intrahepatic cholestasis of pregnancy?

Answer 10

Multi factorial, however, thought to be related to pregnancy hormones (namely progesterone) decreasing biliary contraction, leading to stasis +/- development of stones