Cholestasis Treatment in Pinellas County, FL
Cholestasis: one more thing to worry about when you’re pregnant. This slowing or complete blockage of bile flow can occur in the liver (intrahepatic) or outside the liver (extrahepatic). Hormonally induced blockage during pregnancy is called obstetric cholestasis.
If you’re struggling with intense itching, abdominal pain, and yellowing skin, a healthcare provider can help determine if your bile has anything to do with it. If you’re looking for cholestasis treatment in Pinellas County, call (813) 536-3212 or contact Dr. Christopher Van Benschoten online.
What are the symptoms of cholestasis?
Intense itching without a rash is a common symptom of cholestasis. The itching can occur anywhere, though it commonly occurs on the palms of your hands or the soles of your feet. While mild itching is common during pregnancy, a symptom like itchy legs during pregnancy may indicate cholestasis. Sometimes, the itching can be so intense that it disrupts your sleep.
Both cholestasis and cholestasis of pregnancy can also cause the following symptoms:
- abdominal pain
- foul-smelling, light-colored stool
- dark urine
- low mineral absorption
- appetite loss
Due to a lack of bile in your intestine, vitamins and minerals like calcium, vitamin D, and vitamin K are not properly absorbed, leading to a deficiency. The metabolic bone disease often occurs, and a vitamin K deficiency also causes you to bleed more easily (as the mineral is important in blood clotting).
Mothers with cholestasis of pregnancy may have an increased risk of:
Cholestasis of pregnancy can also cause premature birth, lung issues, or stillbirth.
There is no known way to prevent cholestasis or cholestasis of pregnancy, though you can lower your risk by getting the hepatitis B vaccine, by not abusing alcohol, and by not abusing intravenous drugs.
What causes cholestasis?
Produced by the liver and stored in the gallbladder, bile normally moves via your bile ducts into your small intestine. Bilirubin (waste created from the break-down of red blood cells) joins this bile and is removed from your body via stool and urine. When your bile is blocked, bilirubin has nowhere to go, enters your bloodstream, and is carried to other parts of your body (like your skin and urine).
These medications can disrupt your liver’s ability to break down food:
- antibiotics like amoxicillin and minocycline
- anabolic steroids
- nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen
- certain antipsychotics like chlorpromazine
- oral contraceptives
- immunosuppressants like azathioprine
These liver diseases can also cause cholestasis:
- liver cancer
- primary biliary cirrhosis
- hepatitis B or C
- alcoholic liver disease
Other diseases that can cause cholestasis include:
- bile duct stones
- narrowing of the bile duct
- Epstein-Barr virus
- pancreatic cancer
- lymphoma cancer
- non-Hodgkin lymphoma1
- Hodgkin lymphoma1
- gallstones and liver failure from sickle-cell disease1
- heart failure (which can cause elevated bilirubin levels)1
Cholestasis often affects HIV patients, either via antiviral and antimicrobial medication or as a result of liver infections.2
Obstetric cholestasis is caused by hormonal changes that occur during pregnancy when hormones slow the movement of bile through your bile ducts. A family history of cholestasis or liver disease and carrying twins are risk factors.
How is cholestasis diagnosed?
Your healthcare provider will analyze your medical history and inquire about any liver-damaging drugs that you may be taking. A physical exam can also detect abdominal pain and tenderness.
Blood tests can track levels of alkaline phosphatase, gamma-glutamyl transpeptidase, and bilirubin which are very high in cholestasis patients.
If your blood tests are abnormal, imaging tests like an ultrasound, CT scan, or MRI are usually performed to detect abnormalities in your liver or gallbladder. Sometimes, an ultrasound is done with an endoscope, which is a thin viewing tube inserted through your mouth and into your small intestine (endoscopic ultrasonography). An MRI can also be performed in a similar manner. Sometimes, an endoscope can inject a substance into your bile and pancreatic ducts that allows detailed images to appear on an x-ray.
If these tests indicate liver damage, a liver biopsy can be done. If you have cholestasis of pregnancy, your healthcare provider may recommend close monitoring.
As with any medical procedure, results of cholestasis treatment will vary from patient to patient depending on age, genetics, general health, condition severity, follow-up care, and environmental factors. The following pharmaceutical, regenerative, nutritional, and herbal treatments may present contraindications with one another, and/or with other medical conditions. Always consult your healthcare professional before deciding which treatment to try first.
The rash associated with pregnancy can be caused by:
- inflammatory disorders such as psoriasis
- infections such as candida
- auto-immune disorders such as systemic lupus erythematosus (SLE)
- metabolic disorders such as acrodermatitis
- cutaneous tumors
By stimulating liver, stomach, bladder and gall bladder meridians your acupuncturists can reverse each of the hormonal and nutrient deficiencies that stimulate these disorders. An herb prescription may also be written for a more thorough synergistic effect.
Cool oatmeal baths, lotions, creams, or ice can help to reduce itching. Applying a baking soda bath can also help increase your comfort, as can aqueous cream containing 2% menthol.3
These botanical herbs can help address biochemical imbalances:
- guar gum: encourages the intestinal binding of bile; side effects include gas and diarrhea
- milk thistle: commonly used to detoxify the liver, shown to help prevent cholestasis caused by estrogen and bile acid by increasing the activity of the bile salt export pump;4 side effects include diarrhea, nausea, abdominal pain, and a feeling of fullness
- dandelion root: can help improve bile flow in pregnancy
Vitamin and mineral deficiencies can be addressed with these supplements:
- vitamin K: improves blood clotting
- vitamin D: enables calcium absorption, preventing rickets and osteoporosis; high doses may cause fatigue and headaches
- calcium: replenishes this nutrient which cholestasis shuts down production of
- S-adenosyl-L-methionine (SAMe): increases hormone methylation (the biological transfer of four atoms) and the removal of the hormone metabolites via biliary excretion;5 may reduce itching; side effects include vomiting, diarrhea, constipation, dizziness, nervousness, and mild insomnia
- activated charcoal: lowers bile acid levels by removing it from the body; may cause constipation or black stools
If it is suspected that a certain medication is the cause of your cholestasis, you should stop taking that medication immediately.
Drugs that can be used to treat cholestasis include:
- oral cholesterol: used to treat itching; side effects include diarrhea, constipation, nausea, muscle pain, and headache
- ursodiol: used in pregnancy, this drug helps lower the amount of bile in the blood and reduce itching; side effects include diarrhea, constipation, vomiting, sore throat, and back pain
- diphenhydramine: this antihistamine eases nausea and dizziness of pregnancy;3 side effects include upset stomach, vision changes, and dry mouth
If cholestasis is being caused by something like a gallstone or a tumor, surgery can remove them or clear any other cause of a blocked bile duct. These surgeries can sometimes be done with an endoscope. As cholestasis of pregnancy can potentially harm your baby, your healthcare provider may want to induce your labor early.
Request your appointment now
Like most liver diseases, cholestasis can cause severe pain. Thankfully, there are many treatments available to help clear your blockage. If you’re struggling with jaundice or itchy breasts during pregnancy, find a Pinellas County cholestasis specialist today by calling (813) 536-3212 or contact Dr. Christopher Van Benschoten online.
1. Delemos, Andrew S., and Lawrence S. Friedman. “Systemic Causes of Cholestasis.” Clinics in Liver Disease, vol. 17, no. 2, 2013, pp. 301–317., doi:10.1016/j.cld.2012.11.001.
2. Te, Helen S. “Cholestasis in HIV-Infected Patients.” Clinics in Liver Disease, vol. 8, no. 1, 2004, pp. 213–228., doi:10.1016/s1089-3261(03)00129-6.
3. Gabzdyl, Elizabeth M., and Judith M. Schlaeger. “Intrahepatic Cholestasis of Pregnancy.” The Journal of Perinatal & Neonatal Nursing, vol. 29, no. 1, Jan. 2015, pp. 41–50., doi:10.1097/jpn.0000000000000077.
4. Hackett, E.s., et al. “Milk Thistle and Its Derivative Compounds: A Review of Opportunities for Treatment of Liver Disease.” Journal of Veterinary Internal Medicine, vol. 27, no. 1, 9 Nov. 2012, pp. 10–16., doi:10.1111/jvim.12002.
5. Zhang, Yang, et al. “Ursodeoxycholic Acid and S-Adenosylmethionine for the Treatment of Intrahepatic Cholestasis of Pregnancy: A Meta-Analysis.” Hepatitis Monthly, vol. 16, no. 8, 23 Aug. 2016, doi:10.5812/hepatmon.38558.
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