Let's learn about "bile retention" or cholestasis.

Have you ever heard of “bile blockage” or “gallstones”? You may have seen some people whose eyes and skin turn yellow. Have you ever wondered what these things really are and why they happen? Today we are going to talk about such a condition. It is medically called cholestasis. Don’t worry, let’s explain it simply.

What is Cholestasis?

Simply put, cholestasis is when the flow of bile from your liver slows down or stops completely. Think of it like a small factory in our body. It produces a substance called bile . This bile helps us digest the food we eat, especially fatty foods.

The liver produces this bile and sends it to our digestive system through a network of small tubes called bile ducts . Some of these bile ducts are inside the liver (intrahepatic ducts) and some are outside the liver (extrahepatic ducts). This system of ducts connects the liver, gallbladder, pancreas , and small intestine. Together, these make up the biliary system .

Now imagine, what happens if there is a blockage or blockage somewhere in this bile duct system? It's like a clogged water pipe. Bile cannot flow properly. Then this bile starts to accumulate in the bile ducts and related organs like the liver. This can damage those tissues and interfere with their functioning. Not only that, but this accumulated bile gradually starts to leak into the blood. This is harmful and toxic to the body. This can cause uncomfortable symptoms and, over time, can lead to various diseases. Cholestasis can sometimes be a temporary problem, or it can be a problem that gradually increases and is ongoing.

How does this affect your body?

Cholestasis can affect your body in various ways.

Short-term effects:

The first thing that is affected is the organs in your biliary system. The buildup of bile can cause the liver, gallbladder, pancreas, or bile ducts to swell and become inflamed . This can cause symptoms like stomach pain and nausea. It also increases the risk of infection.

Also, because the small intestine doesn't get enough bile, the fats in the food you eat aren't digested properly. This can cause bloating, indigestion, and diarrhea.

Long-term effects:

If this situation continues, more problems may arise.

• The accumulation of bile in the blood can cause jaundice , which is a yellowing of the eyes and skin, and dark urine.
• Some people may experience severe itching (pruritus) . This is because bile salts in the blood stimulate the nerves.
• Prolonged inflammation of organs like the liver can lead to scarring and permanent loss of function. This is also called cirrhosis .
• Fat-soluble vitamins, such as vitamins A , D, E, and K , are not absorbed properly by the body. This can lead to malnutrition. This can be a cause of stunted growth, especially in young children.

Especially remember!

Obstetric cholestasis during pregnancy increases the risk of life-threatening complications for both the mother and the fetus. These include preeclampsia, premature birth, and stillbirth. Therefore, it is important to seek medical advice immediately if you experience these symptoms during pregnancy.

What are the main reasons for this?

There are many causes of cholestasis. In general, there are two types of problems:

What are the symptoms of cholestasis?

There are several symptoms that are commonly seen in this condition:

• Jaundice: Yellowing of your skin and the whites of your eyes is often the first sign that your liver is not working properly. This is caused by a buildup of bile in the blood. Specifically, a pigment called bilirubin in bile is responsible for this yellow color. Sometimes, bilirubin is also excreted in the urine, which can turn the urine a dark yellow/brown color.
• Light-colored poop: This is because bile is not properly moving through the intestines, which can cause changes in stool. When bile is not available to digest fats, the fats are passed out with the stool. This type of poop is white, clay-colored. Also, this light color is due to the lack of bilirubin (usually, stool is brown because of bilirubin). These may float in water and have a strong odor.
• Pruritus: This is another common symptom seen in cholestasis. Itching related to bile occurs when bile salts or bile acids accumulate in the blood and stimulate the nerves of the peripheral nervous system. This itching does not cause any rash. Some people are more sensitive to these bile salts. Some people have less itching, while others have a lot of it. The itching may be more on the palms, soles, and limbs, and the whole body may itch.

In addition to these main symptoms, other symptoms may occur depending on the cause of cholestasis.

• Abdominal pain
• Nausea and vomiting
• Fatigue

How do you recognize this?

If you have symptoms of cholestasis, the first thing a doctor will do is test a sample of your blood.

• Blood tests: These check for elevated levels of bilirubin and bile salts. They also check for elevated levels of cholesterol and certain liver enzymes, such as gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP). These can give some idea of ​​the cause of the disease.
• Imaging tests: If blood tests suggest disease, the next step is to have imaging tests to look at your biliary system. These can start with simple, non-invasive tests like an abdominal ultrasound or an abdominal CT scan. These can look for physical blockages in the bile ducts and swelling in the organs.
• Exploratory exams: Some cholestasis causes require internal examinations to find and treat the cause. The doctor may need to examine the bile ducts or take a small piece of tissue from the liver (a liver biopsy) for testing in a lab. During an ERCP (Endoscopic Retrograde Cholangiopancreatography) , doctors can look for and treat problems with the bile ducts.

How is it treated?

The treatment for cholestasis depends on the underlying cause.

• Acute causes: Some causes can be treated relatively easily. The drugs that are causing the problem can be replaced with other drugs. Antibiotics or antivirals can be given for infections. Bile duct obstructions can be removed with endoscopic procedures such as ERCP.
• Chronic causes: Chronic causes of liver disease can be difficult to treat. Some diseases have no permanent cure, and scarring of the liver (cirrhosis) cannot be reversed. However, lifestyle changes such as diet, exercise, and alcohol avoidance can help control the progression of many liver diseases. In the meantime, your doctor will focus on treating the side effects of your condition.

Treatments may include:

• Nutrition: Dietary changes and nutritional supplements can help prevent malnutrition and vitamin deficiencies.
• Ursodeoxycholic acid: This medication is usually used to dissolve gallstones, but it can also sometimes help with cholestasis by increasing bile production and reducing the effects of excess bile salts in the blood.
• Naltrexone: This opioid antagonist is sometimes used to treat severe itching. It works by blocking nerve pathways that are stimulated by bile acids in the blood.
• Cholestyramine: This cholesterol-lowering drug binds cholesterol with bile salts in the intestine, allowing more of it to be excreted in the stool.