Diagnostic and therapeutic approach to cholestatic liver disease.

[benign recurrent intrahepatic cholestasis]

When cholestatic liver disease is present , liver ultrasound should be performed to ascertain if cholestasis is extrahepatic or intrahepatic . If bile ducts appear dilated and the probability of interventional treatment is high , endoscopic retrograde cholagio-pancreatography (ERCP ) or trans-hepatic cholangiography (THC ) should be the next step . If the probability of interventional therapeutics is low , cholangio-MRI should be performed . Once bile duct dilation and space occupying lesions are excluded , a work up for intrahepatic cholestasis should be started . Some specific clinical situations may be helpful in the diagnostic strategy . If cholestasis occurs in the elderly , drug-induced cholestatic disease should be suspected , whereas if it occurs in young people with risk factors , cholestatic viral hepatitis is the most likely diagnosis . During the first trimester of pregnancy cholestasis may occur in hyperemesis gravidorum , and in the third trimester of gestation cholestasis of pregnancy should be suspected . A familial history of recurrent cholestasis points to benign recurrent intrahepatic cholestasis . The occurrence of intrahepatic cholestasis in a middle -aged woman is a frequent presentation of primary biliary cirrhosis , whereas primary sclerosing cholangitis should be suspected in young males with inflammatory bowel disease . The presence of vascular spider nevi , ascites , and a history of alcohol abuse should point to alcoholic hepatitis . Neonatal cholestasis syndromes include CMV , toxoplasma and rubinfections or metabolic defects such as cystic fibrosis , alpha 1 -antitrypsin deficiency , bile acid synthesis defects , or biliary atresia . The treatment of cholestasis should include a management of complications such as pruritus , osteopenia and correction of fat soluble vitamin deficiencies . When hepatocellular failure or portal hypertension -related complications occur , liver transplantation should be considered .

Diseases
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Diseases presenting "whereas primary sclerosing cholangitis should be suspected in young males with inflammatory bowel disease" symptom

benign recurrent intrahepatic cholestasis

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