Cholestasis Causes | Obstructive Cholestasis | Symptoms of Cholestasis

What is Cholestasis

When cystic duct of the gall bladder gets obstructed, causing inflammation of the gall bladder (cholecystitis), it is known as cholestasis. In about 90% of cases inflammation of the gallbladder is associated with calculi (stone). Whether the stones are the cause or the effect is yet to be proved. In about 60% of cases of acute cholestasis bile culture is positive which shows bacterial inflammation of gallbladder.

Causes of Cholestasis

  • Stones in gallbladder obstructing the cystic duct can be implicated in up to 80% of cases of acute cholecystitis.
  • Even in the absence of stones at surgery or autopsy, obstructive factor cannot be excluded since the stones might have passed into the common bile duct and gastrointestinal tract.
  • Kinking of gallbladder or duct or pressure from anomalous vessel or from adjacent structures may cause non-calculus obstruction.
  • Edema or erosion caused by the stone may also cause obstruction of outlet of gall-bladder.

Obstructive Cholestasis

  • Obstruction will cause stasis of bile leading to progressive concentration of bile and chemical irritation of the gallbladder wall.
  • Hydrops (edema) of the gallbladder, in which the outlet obstructed by a stone, produces marked distension, but acute inflammation does not follow.
  • Simple outlet obstruction cannot cause acute cholecystitis until and unless it is added with some other factor or factors.

Symptoms of Cholestasis

  • The gall-bladder is usually enlarged 2 to 3 times.
    It becomes bright red or violet to greenish-black in color.
  • When the content exudate is virtually pure pus, the condition is called ‘Empyema of the gall-bladder’.
  • Cystic obstruction is essential for empyema.
  • Gall-stones are usually present in 80% of the cases.
  • Gangrene may set in and cause perforation of gall-bladder.
  • Perforation through the site of gangrene may give rise to
  1. Biliary peritonitis.
  2. Localized pericholecystic abscess or local abscess due to peritoneum adherent to surrounding viscera.
  3. Fistula- rarely the gangrenous area of the gall-bladder becomes adherent to the wall of the duodenum or the small intestine. In such cases gallstone may pass through such fistula into the small intestine.
  4. If the stone is sufficiently large it may be impacted at the distal part of the ileum near the junction of ileum and caecum, causing intestinal obstruction. This is known as gallstone ileus.

Diagnosis of Cholestasis

  • Straight X-ray of the abdomen, ultrasonography, cholecystography and cholescintigraphy helps in confirming the diagnosis.
  • In blood investigations, leucocytosis (increased WBC) and elevation of serum bilirubin and serum amylase is present.