Bile flow disorders can occur from Hepatocyte ， Bile canaliculus reach Vater ampulla Any part of the whole access road. It is important to distinguish the causes of intrahepatic and extrahepatic diseases clinically. Cholestasis due to extrahepatic causes is common in Choledocholithiasis Or pancreatic duct cancer. other Not common The reasons for Common bile duct Benign stenosis (often compared with previous surgical operation About), Cholangiocarcinoma ， pancreatitis or pancreatic pseudocyst as well as Sclerosing cholangitis 。 Molecular mechanism of occurrence
Announce Basal lateral membrane and capillaries of hepatic sinus bile duct Membrane change; Cytoskeleton Change; Bile secretion Abnormal regulation; Paracellular permeability Increase; Capillary bile duct and intrahepatic Biliary obstruction 。 1． jaundice Is it caused by cholestasis? clinical manifestation : The main symptoms are jaundice and skin itch 。 The depth and duration of jaundice vary depending on the etiology. skin Itch May appear in jaundice Occurred before In the late stage of cholestatic liver disease, itching may disappear. Long term severe cholestasis visible skin Xanthoma 。 The secondary manifestations of cholestasis include: fat absorption disorder Steatorrhea ， Fat soluble vitamin D、K、A Malabsorption Resulting Osteopathy 、 Night blindness and Bleeding tendency Etc. Laboratory and Supplementary Examination : Key exclusion Hepatocellular jaundice and Hemolytic jaundice 。 Main combination Increased bilirubin ； serum Elevated alkaline phosphatase is the most characteristic of cholestasis Abnormal liver function , usually first; Serum γ - glutamyltranspeptidase is increased to varying degrees in most cholestasis diseases; Patients with chronic cholestasis blood fat Often significantly increased, mainly phospholipid and total cholesterol 。 Serum lipoproteins also increased Low density lipoprotein Increase, High density lipoprotein Lower. There is an abnormal Lipoprotein X (It belongs to low density lipoprotein), which is of differential significance. Imaging Check whether there is biliary obstruction and the specific cause of obstruction. 2. Explore the cause of cholestasis
To determine whether it is intrahepatic or extrahepatic cholestasis, ultrasound, CT, MRCP/ERCP/PTC/ Endoscopic ultrasound Etc. yes Intrahepatic cholestasis It should also be clear that genetic still Acquirability The identification of hereditary cholestasis is based on the elimination of acquired causes, which should generally be done Hepatic puncture To explore the liver Substantive pathological changes. If possible, efforts should be made to cure or control cholestasis with clear basic causes Basic diseases 。 as tumour 、 stone Obstruction can be caused by radical tumor resection or ERCP Quarrying; Repairing biliary stricture can make biliary drainage return to normal; Choledocholic Immunity Damage, Immunosuppressant May be effective; For drug-induced cholestasis, relevant drugs shall be stopped in time. Ursodeoxycholic acid Polyene phosphonoyl choline Capsules Adenosylmethionine 、 Phenobarbital 。 Traditional Chinese medicine preparation yes Cholagogue It has the function of reducing yellowness and enzymes, such as Bupleurum chinense, Paeonia lactiflora, Artemisia argyi, Salvia miltiorrhiza, etc; The treatment of itching can supplement fat soluble vitamins, calcium and vitamin D 。 3. Liver transplantation
Some types of end-stage cholestasis diseases such as Primary biliary cirrhosis （PBC）、 Primary sclerosing cholangitis （PSC）、 Biliary atresia Patient, 1 year survival rate About 90%.
