What is Cholestasis? What is Jaundice?
Cholestasis is a condition where bile cannot flow from the liver to the duodenum. Jaundice, on the other hand, refers to the yellow discoloration of the skin and eyes due to elevated levels of bilirubin in the blood. While all cases of cholestasis can cause jaundice, not all jaundice is caused by cholestasis.
Both are symptoms of an underlying liver or biliary system issue and should be investigated promptly.
Difference Between Jaundice and Cholestasis
| Feature | Cholestasis | Jaundice |
|---|---|---|
| Definition | Impaired bile flow | Yellow pigmentation |
| Bilirubin Type | Conjugated usually | Either unconjugated or conjugated |
| Stools | Pale/clay colored | May be normal or dark |
| Urine | Dark colored | Often dark if conjugated |
Early Symptoms of Cholestasis or Jaundice
- Yellowing of skin and eyes
- Dark-colored urine
- Fatigue
- Nausea and vomiting
- Loss of appetite
- Right upper quadrant abdominal pain
These may appear subtly before progressing to more severe symptoms like weight loss, bleeding, or neurological changes.
Full Symptom List (Explained with Visual Clues)
Based on the image, the following are key symptoms of cholestasis or jaundice:
Fever with chills & rigor
- Suggests infection like ascending cholangitis
Nausea and vomiting
- Due to bile salt accumulation and liver dysfunction
Anaemia, fatigue, muscle pain
- Suggests chronic liver disease and nutritional deficiencies
Pale and yellow skin/mucosa
- Classic jaundice indicator (bilirubin >2.5 mg/dL)
Yellow sclera
- One of the earliest signs of bilirubin deposition
Dark-colored urine
- From increased conjugated bilirubin excretion via kidneys
Dark-colored stools
- Could indicate upper GI bleeding or excess bilirubin excretion
Swelling of the legs
- Hypoalbuminemia due to poor liver synthesis
Haemorrhagic features
- Due to decreased clotting factor production in liver
Bone pain
- Common in cholestatic syndromes due to vitamin D malabsorption
Weight loss & abdominal pain
- May indicate malignancy or chronic biliary disease
Common Causes of Jaundice
| Category | Examples |
|---|---|
| Pre-hepatic | Hemolysis, malaria |
| Hepatic | Hepatitis, cirrhosis, alcoholic liver disease |
| Post-hepatic | Gallstones, cholangiocarcinoma, pancreatic cancer |
Liver Function and Bile Flow Explained
The liver metabolizes hemoglobin into bilirubin, which is:
- Unconjugated → bound to albumin → sent to liver
- Conjugated → water-soluble → excreted in bile
In cholestasis, bile can't flow, so conjugated bilirubin leaks into the bloodstream, causing:
- Yellowing of skin
- Itching
- Clay-colored stools
Types of Jaundice: Pre-Hepatic, Hepatic, Post-Hepatic
| Type | Cause | Key Features |
|---|---|---|
| Pre-hepatic | Hemolysis | ↑ Unconjugated bilirubin, no dark urine |
| Hepatic | Hepatitis, liver failure | Mixed bilirubin, transaminitis |
| Post-hepatic | Stones, tumors, strictures | ↑ Conjugated bilirubin, dark urine, pale stools |
Diagnosing Jaundice: Blood Tests, Imaging & Liver Biopsy
Blood Tests
- LFTs (ALT, AST, ALP, GGT)
- Bilirubin (total, direct, indirect)
- PT/INR – for liver synthetic function
Imaging
- Ultrasound – first-line for biliary obstruction
- MRCP or ERCP – for detailed ductal visualization
Liver Biopsy
- Indicated in autoimmune or unclear hepatic causes
When Jaundice Indicates an Emergency
Seek urgent help if:
- There is altered mental status (hepatic encephalopathy)
- Bleeding from gums, nose, or GI tract
- Rapid abdominal distension
- High-grade fever with jaundice (Charcot’s triad = fever, jaundice, RUQ pain = cholangitis)
Treatment Strategies for Cholestasis and Jaundice
| Cause | Treatment |
|---|---|
| Gallstones | ERCP or surgery |
| Hepatitis A/B/C | Antivirals, supportive care |
| Drug-induced | Withdrawal of offending drug |
| Cirrhosis | Liver transplant (in severe cases) |
| Cholestasis in pregnancy | Ursodeoxycholic acid |
Cholestasis in Pregnancy (Intrahepatic Cholestasis of Pregnancy – ICP)
- Occurs in the 3rd trimester
- Pruritus is often the first symptom, followed by jaundice
- Can cause fetal distress or preterm delivery
- Treated with Ursodeoxycholic acid
Cholestatic Jaundice in Children and Neonates
- Common causes: Biliary atresia, neonatal hepatitis
- Warning sign: Prolonged jaundice beyond 2 weeks
- Requires pediatric GI referral and often surgery
Prevention Tips and Liver Health
- Avoid excessive alcohol
- Get vaccinated against hepatitis A & B
- Maintain healthy weight
- Avoid self-medication (e.g. herbal or OTC hepatotoxins)
- Screen for liver disease in high-risk individuals (diabetics, obese, alcoholics)
Summary Chart: Symptom vs. Cause
| Symptom | Likely Cause |
|---|---|
| Dark urine + pale stool | Cholestasis |
| Yellow skin + itching | Bile salt deposition |
| Bone pain | Vitamin D deficiency (fat malabsorption) |
| Hemorrhagic features | Clotting factor deficiency |
Final Thoughts and Recap
Cholestasis and jaundice are not diseases in themselves but signs of underlying disorders. From mild hepatitis to life-threatening cholangitis or cancer, these conditions demand timely diagnosis and treatment. Visual cues like yellow sclera, dark urine, and clay-colored stools are important red flags.
FAQs on Jaundice and Cholestasis
Q1. Is jaundice always liver-related?
No. It can be due to hemolysis or bile duct obstruction as well.
Q2. Can jaundice be cured?
Yes, if the underlying cause is reversible.
Q3. Is jaundice contagious?
Only if caused by infectious hepatitis.
Q4. When should you worry about jaundice?
If accompanied by fever, altered mental status, or weight loss.
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