Diagnosis of cholestatic liver disease

Cholestatic liver disease is a disease that affects a wide range of people, and both the elderly and the young may suffer from this disease. Patients with cholestatic liver disease will have obvious damage to their liver function and their detoxification function will be greatly reduced. Most patients will also have other organ diseases such as stomach problems, which are extremely harmful to the human body. So, how is cholestatic liver disease diagnosed?

Causes

The main causes include genetics, immunity, degeneration, infection, stones and tumors. This disease can affect any part of the entire biliary system from the bile duct formed by two adjacent hepatocytes to the duodenal ampulla, and can be divided into intrahepatic cholestasis and extrahepatic cholestasis. Common causes of intrahepatic cholestasis include viral hepatitis, drug-induced liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis. Extrahepatic cholestasis is caused by mechanical obstruction of the bile duct. Common causes include common bile duct stones, gallbladder cancer, cholangiocarcinoma, etc.

Clinical manifestations

1. Symptoms

Symptoms include fatigue, loss of appetite, itchy skin, dark yellow urine like strong tea, lighter stool color, etc. People with long-term cholestasis may have symptoms of fat and fat-soluble vitamin absorption disorders, such as foul-smelling stools, steatorrhea, night blindness, osteoporosis, fractures, bone pain, testicular atrophy, and bleeding tendency.

2. Physical signs

Jaundice is the most prominent physical sign of the patient, manifested as yellowing of the sclera and skin. Most patients have jaundice, but a few patients or those in the early stages of the disease may not develop jaundice. Skin pigmentation, ecchymoses, petechiae, and enlargement of the liver, spleen, and superficial lymph nodes throughout the body may also occur.

examine

1. Laboratory examination

(1) Elevated serum bilirubin, mainly conjugated bilirubin, negative urobilinogen and positive urine bilirubin.

(2) Alkaline phosphatase may increase before bilirubin increases, and is generally less than 2.5 times the upper limit of normal. In cholestatic liver disease, alkaline phosphatase increases significantly.

(3) Immunological examinations, such as anti-mitochondrial antibodies and anti-nuclear antibodies, are helpful in diagnosing autoimmune liver disease.

(4) Serological examination and hepatitis virus markers are crucial for the etiological diagnosis of cholestasis.

2. Imaging examination

(1) Abdominal ultrasound examination: It helps to differentiate intrahepatic or extrahepatic cholestasis and is the preferred method for detecting or excluding intrahepatic and extrahepatic bile duct dilatation and space-occupying lesions.

(2) Magnetic resonance cholangiopancreatography: It can be used to show diseases of the biliary system and is a non-invasive method.

(3) Endoscopic retrograde pancreaticocholangiopancreatography: It can also be used to display diseases of the biliary system. While imaging, specimens can be taken for cytological and histological examinations. It can also complete treatments such as biliary drainage, dilation, and stent placement.

3. Histopathological examination

Liver tissue pathological examination is an effective method for diagnosing autoimmune liver disease, metabolic and hereditary liver disease, tumor and granulomatous diseases, and it helps to clarify the diagnosis of intrahepatic cholestasis of unknown cause.

diagnosis

1. Clinical manifestations

Jaundice persists for more than 3 weeks with no signs of disappearing, and may even progressively increase. It is accompanied by skin itching, loss of appetite, dark yellow urine like strong tea, and varying degrees of fatigue and gastrointestinal symptoms.

2. Auxiliary examination

The diagnosis is made based on the results of laboratory tests, imaging tests, and other examinations.

treat

1. Treatment of the primary disease is the key.

2. Endoscopy, radiological intervention and surgery are effective methods for treating extrahepatic cholestatic diseases. Treatment of intrahepatic cholestatic disease varies depending on the cause. In addition, related complications need to be actively treated.

3. Cholestasis can lead to vitamin absorption disorders and cause vitamin A, vitamin D, vitamin E, and vitamin K deficiencies, and should be treated with corresponding vitamins.

4. Chronic cholestatic liver disease and hormones can cause or aggravate osteoporosis. Calcium and vitamin D can prevent decalcification.