liver and gallbladder disorders
Cholestasis
Diagnosis of Cholestasis
Blood tests If blood test results are abnormal, an imaging test, usually ultrasonography Sometimes a liver biopsy A doctor suspects cholestasis in people who have jaundice and tries to determine whether the cause is within or outside the liver on the basis of symptoms and the results of a physical examination. Recent use of drugs that can cause cholestasis suggests a cause within the liver. Small spiderlike blood vessels visible in the skin (called spider angiomas), an enlarged spleen, and accumulation of fluid within the abdomen ( Ascites )—which are signs of chronic liver disease—also suggest a cause within the liver. Findings that suggest a cause outside the liver include certain kinds of abdominal pain (such as intermittent pain in the upper right side of the abdomen and sometimes also in the right shoulder) and an enlarged gallbladder (felt during the physical examination or detected by imaging studies). Some symptoms (such as loss of appetite, nausea, and vomiting) do not indicate whether the cause is within or outside the liver. Typically, blood tests are done to measure levels of two enzymes (alkaline phosphatase and gamma-glutamyl transpeptidase) that are very high in people with cholestasis. However, if the level of alkaline phosphatase is very high but the level of gamma-glutamyl transpeptidase is normal, the cause of the high level of alkaline phosphatase is probably not cholestasis. A blood test that measures the level of bilirubin indicates the severity of the cholestasis but not its cause. An Imaging Tests of the Liver and Gallbladder , usually ultrasonography, is almost always done if blood test results are abnormal. Computed tomography (CT) or sometimes magnetic resonance imaging (MRI) may be done in addition to or instead of ultrasonography. If the cause appears to be within the liver, a If the cause appears to be blockage of the bile ducts, more precise images of these ducts are usually needed. Typically, one of the following is done: Endoscopic Retrograde Cholangiopancreatography (ERCP): A flexible viewing tube (endoscope) is inserted through the mouth and into the small intestine, and a radiopaque contrast agent (which can be seen on x-rays) is injected through the tube into the bile and pancreatic ducts. Then, x-rays are taken. Magnetic Resonance Imaging (MRCP): MRCP is MRI of the bile and pancreatic ducts, with specialized techniques that are used to make the fluid in the ducts appear bright and the surrounding tissues appear dark. Endoscopic ultrasonography: Images are obtained via an ultrasound probe inserted with a flexible viewing tube (endoscope) through the mouth and into the small intestine. 