was once called cholangiolitic hepatitis, which is the obstruction of bile
secretion and dysfunction of bile canaliculi in the Golgi apparatus of the
liver cells. During the acute stage of cholestatic hepatitis, electron
microscopy and histo-chemical studies of the liver cell demonstrated that
the cell apparatuses, such as the Golgi apparatus, exhibited degeneration
of the smooth endoreticulum and mitochondria. These components are mainly
responsible for the secretion of bile and as a result, the amount of bile
excreted into duodenal intestine is greatly reduced. The components of
bile (bile acid, bilirubin, cholesterol, and AKP etc.) re-enters into the
blood stream, which causes a group of clinical symptoms including:
jaundice, skin itch, elevation of serum AKP, bilirubin, bile acid, and
albumin. Cholestatic hepatitis is commonly seen in viral, iatrogenic
(drug-caused), and idiopathic cholestatic hepatitis as part of their
infection is the most common cause of cholestatic hepatitis. The incidence
rate of this disease in HAV, HBV, and HCV is around 1 to 2%, 2%, and 9 to
10%, respectively. It can occur during acute, chronic, or fulminant viral
hepatitis and also post-hepatitis cirrhosis. Besides viral cholestatic
hepatitis, there is also chronic active-, drug-, pregnant-,
post-surgical-, alcoholic-, fatty-liver-, Hodgkin-disease-,
congestive-heart-disease-, chronic-pancreatitis- based-cholestatic
hepatitis. In icteric (jaundice) hepatitis, 2 to 8% are cholestatic
hepatitis and in older age groups this proportion is much higher. In order
to distinguish intra- or extra-liver bile obstruction, a B-ultrasound
study is useful.
The main characteristics of this disease are similar to icteric
hepatitis, and subjective symptoms are mild with jaundice being its
main manifestation. The Jaundice usually lasts longer than three weeks.
Itch: Body itch
and rashes will sometimes show at the wrist area, under the breast, or
on the neck and chest or back areas. The itching is mainly caused by
bile acid flooding in the skin, which over-stimulates the nerve
liver: The size of
the liver becomes larger when the blockage of the bile is caused by
extra-liver obstruction than intra-liver bile retention. There is
usually no tenderness while palpating. When cirrhosis has been
developed, the surface of the liver becomes uneven. A mildly enlarged
spleen can be seen in viral, iatrogenic hepatitis. When the spleen is
obviously enlarged, blood pressure in the portal vein is also likely
to be elevated.
and urine color change:
Dark colored urine and light colored stool are very common signs.
and indigestion are common symptoms.
Jaundice is the main manifestation and it lasts longer than three
weeks. Skin itch is usually more severe at night. Rashes can occur on
the neck, chest, back, and wrists. Stool color becomes lighter and
urine color becomes darker. Although there can be many symptoms, the
patient usually will not feel extremely ill.
bilirubin in the serum elevated and its proportion is more than 50% of
the total bilirubin. Serum combined bile acid elevated to 10 to 20
times higher than the normal range. AKP, GGT, cholesterol, and 5-
nucleotidase are obviously elevated, and the ALT elevation is
It can distinguish intra or extra liver obstruction.
Treatments for Cholestatic Hepatitis
therapy: For viral causes, we do not have a very effective anti-viral
treatment protocol available yet. For alcoholic, drug- induced cases,
the most important step is to stop the toxic chemical intake
immediately. About 1/3 of cholestatic hepatitis cases are without
clear causative factors so there is no etiological therapy. If it is
caused by extra-liver bile duct obstruction, removal of the
obstruction via surgery may be considered.
therapy: low fat, low cholesterol diet, for chronic long-term bile
obstruction sufferers, use vitamin K, A, D, and ATP, Co-enzyme A, and
a high protein low fat diet.
treatments: eliminating the jaundice, conventional medicine may use
prednisone with about 60% efficacy, but it may cause undesired side
effects and can cause the underlying disease to worsen. For the skin
itch, 2% magnesium sulfate (Epsom salt) bathing can help to release
the itching. Take six to ten grams of Cholestyramine daily also help
to reduce the itch. Deoxycholic acid can also be used.
treatment principle for this disease is heat-cleansing and
toxic-resolving, bile secretion facilitating, dampness-drying. Herbs and formulas can facilitate bile secretion and excretion from the liver
and increase the bile movement into the intestine. They can also help to
expel small gallstones and act as anti-inflammatory agents to reduce gall