Management of Hepatic Cholestasis

Hepatic cholestasis is characterized by elevated alkaline phosphatase and gama - glutamyl transpeptidase levels which is then followed by conjugated hyperbilirubinemia. It is classified into intrahepatic and extrahepatic cholestasis. Intrahepatic cholestasis indicates hepatocellular dysfunction or the presence of an obstructive lesion in intrahepatic bile ducts distal to biliary canalicular system. The first step in evaluating cholestasis is to distinguish intrahepatic from extrahepatic cholestasis. Abdominal sonography is a sensitive and specific modality to rule out intra- and extrahepatic biliary dilatation. If abnormal biliary tract is present, the next step is to perform Magnetic Resonance Cholangiopancreatography (MRCP) or Endoscopic Ultrasound (EUS). If there was not any evidence of biliary system obstruction in imaging, intrahepatic cholestasis is suggested and to evaluate this condition, initially Antimitochondrial antibody (AMA) should be checked and if the result was negative, liver biopsy should be considered.