Cholestasis - Causes

Causes of extrahepatic cholestasis

Extrahepatic cholestasis develops with mechanical obstruction of the main extrahepatic or main intrahepatic ducts.

1. Stones of the main extrahepatic or main intrahepatic ducts.
2. Damage to the pancreas in the area of the head of the pancreas, which leads to compression of the common bile duct:
   1. tumor;
   2. pancreatitis;
   3. cyst;
   4. abscess.
3. Strictures of extrahepatic bile ducts, stenosis of the duodenal papilla.
4. Ductal tumors.
   1. Primary (cholangiocarcinoma, tumor of the duodenal papilla).
   2. Metastatic.
5. Extrahepatic bile duct cysts.
6. Parasitic infections (opisthorchiasis, fascioliasis, ascariasis, clonorchiasis, echinococcosis).
7. Enlarged lymph nodes in the porta hepatis.
8. Damage to the duodenum (diverticulosis, Crohn's disease).
9. Hepatic artery aneurysm.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Causes of intrahepatic cholestasis

In intrahepatic cholestasis, the pathological process is localized at the level of hepatocytes (hepatocellular cholestasis) or tubules (tubular cholestasis), while there is no obstruction of the main bile ducts.

1. Atresia (hypoplasia) of the intrahepatic bile ducts.
2. Primary biliary cirrhosis of the liver.
3. Primary sclerosing cholangitis.
4. Cholangitis caused by infection (bacteria, cytomegalovirus, protozoa - cryptosporidium).
5. Histiocytosis.
6. Cystic fibrosis is an obstruction of the intrahepatic bile ducts with highly viscous bile.
7. Transplant rejection reaction.
8. Idiopathic ductopenia of adults.
9. Cholangiocarcinoma.
10. Hepatitis (acute, chronic) - cholestatic variant
    1. Viral (especially caused by hepatitis A, C, G viruses, cytomegalovirus, Epstein-Barr virus).
    2. Alcoholic.
    3. Autoimmune.
    4. Due to alpha1-antitrypsin deficiency.
11. Metabolic disorders - deficiency of bile acid synthesis enzymes 3betaC ₂ 7-hydroxysteroid dehydrogenase and 04-3-oxosteroid-5beta-reductase.
12. Progressive intrahepatic familial cholestasis (Byler's syndrome).
13. Benign familial recurrent cholestasis (Summerskill syndrome).
14. Benign cholestasis of pregnancy.
15. Drug-induced cholestasis is most often caused by the following drugs:
    
    1. psychotropic: chlorpromazine, aminazine, diazepam;
    2. antibacterial: erythromycin, ampicillin, oxacillin, nitrofurans, trimethoprim-sulfamethoxazole;
    3. hypoglycemic: chlorpropamide, tolbutamide;
    4. antiarrhythmic: ajmaline;
    5. immunosuppressants: cyclosporine A;
    6. anthelmintic: tibendazole;
    7. Oral contraceptives: estrogens;
    8. anabolic steroids: retabolil, methandrostenolone;
    9. male sex hormones: testosterone, methyltestosterone.