Cholestatic hepatitis

Cholestatic hepatitis is a form of hepatitis in which the process of bile excretion from the liver into the biliary tract is impaired, resulting in the accumulation of bile in the liver. This condition is characterized by inflammation of the liver, impaired liver function and can cause a variety of symptoms and damage to the organ.

An important aspect of liver function is the synthesis and excretion of bile acids, which play a role in the digestive process and are involved in the absorption of fats from food. In cholestatic hepatitis, normal bile output is disrupted, which can cause the following symptoms and conditions:

1. Jaundice: Patients with cholestatic hepatitis may develop jaundice, which is manifested by yellow discoloration of the skin and sclerae (whites of the eyes).
2. Mucosal bleeding: B leeding frommucous membranes such as the gums and gastrointestinal tract may occur.
3. Itching: Patients may experience severe itching of the skin, which is associated with the accumulation of bile acids in the blood.
4. Nausea and vomiting: Symptoms of dyspepsia, i.e., nausea, vomiting, and nonspecific gastric pain, may occur.
5. Fatigue and weakness: These symptoms can be caused by impaired digestion and nutrient absorption.
6. Loss of appetite and weight loss: Patients may lose interest in food and lose weight.

Cholestatic hepatitis can have various causes, including infectious diseases, autoimmune disorders, biliary tract disorders, and other factors. To diagnose and treat this condition, it is important to see a physician who can perform appropriate tests and determine the best treatment plan depending on the underlying cause of cholestatic hepatitis.

Causes of the cholestatic hepatitis

Cholestatic hepatitis can be caused by a variety of reasons, and it is often due to an impaired excretion of bile from the liver. Below are some of the main causes of cholestatic hepatitis:

1. Biliary tract related causes:
   • Gallstone disease: The formation of stones in the gallbladder or bile ducts can block the exit of bile, causing cholestasis (bile stasis) and inflammation of the liver.
   • Intrahepatic bile duct disease: Pathologic changes in the intrahepatic bile ducts can lead to cholestasis and cholestatic hepatitis.
   • Congenital biliary tract anomalies: Some congenital anomalies, such as bile duct atresia, can lead to cholestasis and the development of hepatitis in children.
2. Autoimmune diseases: Auto immune diseases such as primary biliary cirrhosis can cause inflammation and cholestasis by affecting the bile ducts and liver.
3. Infections: Some infections, such as viral hepatitis (e.g., hepatitis A, B, C), can cause cholestasis and inflammation of the liver.
4. Medications: Some medications, including antibiotics, antidepressants, antihypertensives, and others, can cause cholestasis and damage the liver.
5. Liver disease: Some liver diseases, such as cirrhosis, may impair liver function and cause cholestasis.
6. Pregnancy: Some women may develop cholestatic conditions such as pregnancy cholestasis, which can cause cholestasis and liver inflammation.
7. Other factors: Pathologic processes associated with digestive disorders, metabolic disorders, or heredity may also be a cause of cholestatic hepatitis.

Pathogenesis

The pathogenesis of cholestatic hepatitis is associated with impaired bile-forming and biliary function of the liver. Here are the main points concerning the pathogenesis of this condition:

1. Liver protection: The liver has many functions, including processing and metabolizing many substances, including bile acids. Bile acids, which are produced in the liver, are part of the digestive process and help in the absorption of fats.
2. Bile outflow disorder: In cholestatic hepatitis, there are disorders that prevent the free outflow of bile from the liver. This can be caused by various factors such as inflammation, biliary tract disorders, liver structure abnormalities, or bile acid synthesis disorders.
3. Bile Acid Accumulation: As a result of impaired bile flow, bile acids can begin to accumulate in the liver and blood. This can lead to symptoms characteristic of cholestatic hepatitis, including jaundice, itching, abdominal pain, and other symptoms.
4. Inflammation and liver damage: A buildup of bile acids in the liver can cause inflammation and damage to hepatocytes (liver cells), leading to cholestatic hepatitis.
5. Pathologic changes: As a result of prolonged cholestasis (impaired bile outflow), pathologic changes in the liver such as cirrhosis and fibrosis may develop.

Symptoms of the cholestatic hepatitis

This condition can have a variety of symptoms including:

1. Jaundice: One of the most characteristic signs of cholestatic hepatitis is jaundice, in which the skin and sclerae of the eyes take on a yellow hue due to the accumulation of bilirubin in the blood.
2. Itching: Patients with cholestatic hepatitis often experience intense itching (pruritus). The itching can be particularly excruciating and spread all over the body.
3. Dark urine: Urine may become dark due to elevated bilirubin.
4. Light colored stool: Stool may become lighter because it may lack stercobilin, which gives stool its normal color.
5. Fatigue and weakness: Patients may feel weakness, fatigue and general malaise.
6. Upper abdominal pain: Pain or discomfort in the upper abdomen may be associated with enlargement of the liver and bile ducts.
7. Loss of appetite: Loss of appetite and an unpleasant aftertaste when eating can also be symptoms of cholestatic hepatitis.
8. Other symptoms: In addition, some patients may experience general symptoms such as nausea, vomiting, joint and muscle pain, and fever.

Cholestatic hepatitis in children

It is a condition in which children develop inflammation of the liver caused by cholestasis, that is, impaired excretion of bile from the liver. This condition can have different causes and can vary in severity. Here are some of the most common forms of cholestatic hepatitis in children:

1. Pregnancy cholestasis: This condition can occur in some newborn babies of mothers who have had cholestasis (bile flow disorder) during pregnancy. It usually goes away after birth but requires close monitoring and care.
2. Bile duct atresia: This is a congenital disorder in which one or more bile ducts in the liver are blocked or missing. It can lead to cholestasis and, if left untreated, cirrhosis.
3. Pediatric primary biliary cirrhosis: This is a rare autoimmune disease in which the bile ducts in the liver gradually collapse, causing cholestasis and inflammation of the liver. It can occur in children and adolescents.
4. Hepatitis and viral infections: Some viral infections such as hepatitis A, B, C, and others can cause cholestasis and liver inflammation in children.
5. Medications and toxins: Some medications and chemicals can cause cholestasis and liver damage in children if they are ingested.

Treatment of cholestatic hepatitis in children depends on its cause and severity. Some cases require medication, diet, and special supportive measures. More severe cases may require surgery, such as intestinal bypass surgery, to restore the normal flow of bile. Treatment should always be supervised by a doctor who specializes in pediatric liver disease.

Diagnostics of the cholestatic hepatitis

Diagnosis of cholestatic hepatitis involves various medical tests and clinical evaluations. This is important for determining the presence and extent of the disease, selecting appropriate treatment, and assessing prognosis. Here are the main diagnostic methods and steps:

1. Gathering medical and anamnestic information: The doctor begins by discussing the patient's medical history, including symptoms, the nature of the pain, medications taken, whether the patient has relatives with similar conditions, and other important factors.

2. Physical Examination: The physician performs a physical examination of the patient to look for signs and symptoms associated with hepatitis, such as jaundice of the skin and white of the eyes, enlarged liver and spleen, and palpable soreness.

3. Laboratory tests: The following laboratory tests are performed to diagnose cholestatic hepatitis:

   • Biochemical blood tests: Determination of levels of biochemical markers such as bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP) to assess liver function.
   • Viral hepatitis marker tests: To rule out viral forms of hepatitis (e.g., viral hepatitis B and C).
   • Antibody and immunologic marker tests: Check for antibodies and markers associated with cholestatic hepatitis or autoimmune liver disease.
   • Bile Acid Level Tests: Measurement of bile acid levels in the blood, which is a characteristic feature of cholestatic hepatitis.

4. Instrumental studies: In some cases, educational techniques such as ultrasound (USG) or magnetic resonance imaging (MRI) may be required to visualize the liver and biliary tract.

5. Liver biopsy: Your doctor may order a liver biopsy to obtain a tissue sample for detailed analysis and to assess the extent of the damage.

6. Exclusion of other causes: It is important to rule out other liver diseases that can mimic cholestatic hepatitis, such as fatty hepatosclerosis, alcoholic hepatitis, etc.

Once all necessary tests have been performed and results are available, the doctor can diagnose cholestatic hepatitis and develop a treatment plan that may include pharmacotherapy, diet, and liver support measures.

Differential diagnosis

The differential diagnosis of cholestatic hepatitis involves the process of ruling out other diseases and conditions that may present with symptoms and laboratory values similar to cholestatic hepatitis. Below are some of the most common diseases and conditions to consider in the differential diagnosis:

1. Viral Hepatitis: Viral infections such as hepatitis A, B, C and others can cause symptoms of hepatitis, including jaundice and liver damage.
2. Liver cirrhosis: This is a chronic condition in which the liver undergoes long-term damage and is replaced by connective tissue. It may be accompanied by cholestasis and symptoms similar to hepatitis.
3. Alcoholic Hepatitis: Over consumption of alcohol can cause inflammation and damage to the liver, which can also manifest with symptoms similar to cholestatic hepatitis.
4. Pancreas: Diseases of the pancreas, such as pancreatitis, can cause similar symptoms and digestive system disorders.
5. Metabolic disorders: Some metabolic disorders, such as hereditary liver and biliary tract diseases, may be a cause of cholestasis.
6. Liver tumors: Malignant and benign liver tumors can affect liver function and cause symptoms similar to hepatitis.
7. Drugs and toxins: Some drugs and chemicals can cause liver damage and cholestasis.

For the differential diagnosis of cholestatic hepatitis, it is important to perform an extensive examination, including laboratory tests, imaging techniques (e.g., ultrasound, MRI, CT scan) and, if necessary, liver biopsy. An accurate diagnosis allows for proper treatment and management of the disease. Only a qualified physician can make a differential diagnosis and develop a treatment plan.

Treatment of the cholestatic hepatitis

Treatment of cholestatic hepatitis depends on its cause, severity and general condition of the patient. The main goal of treatment is to eliminate cholestasis (impaired bile outflow) and reduce inflammation in the liver. Treatment may include the following measures:

1. Identify and treat the underlying cause: If cholestatic hepatitis is associated with a specific medical or drug condition, that underlying cause should be treated first.

2. Drug therapy:

   • Bile acid levels in the body can be lowered with medications such as ursodeoxycholic acid (UDCA), which helps improve the flow of bile.
   • Cases with autoimmune cholestatic hepatitis may require immunosuppressive drugs such as azathioprine and pednisolone to reduce inflammation and suppress the immune response.

3. Symptomatic treatment:

   • Opioid receptor antagonists, antihistamines, and other medications may be used to relieve symptoms such as itching and jaundice.
   • It is important to make sure to maintain a proper balance of electrolytes and vitamin and mineral levels in the body, as cholestasis can affect digestion and nutrient absorption.
4. Physical therapy: Physical therapy can help restore liver function and reduce pain.
5. Regular follow-up: Patients with cholestatic hepatitis should be seen regularly by a physician or gastroenterologist to monitor liver health and the effectiveness of treatment.
6. Diet: Patients may be advised to follow a diet that limits fats and helps reduce the burden on the liver. Dietary recommendations should be individualized by a physician.