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INTRAHEPATIC CHOLESTASIS

Cholestasis is bile formation and/or bile flow impairment that manifests as fatigue, pruritus and jaundice.
It can be classified into intrahepatic or extrahepatic cholestasis.
Extrahepatic cholestasis develops from mechanical blockage in the duct system or hepatocellular defects.
Intrahepatic cholestasis may be due to functional defects hepatocellularly or from obstructive lesions of the intrahepatic biliary tract distal from the bile canaliculi.

Intrahepatic%20cholestasis Management

Management

Follow Up

In patients with PSC, suspect cholangiocarcinoma if with weight loss, worsening cholestasis, elevated serum level of CA 19-9, and/or new or progressive stricture, especially with an enhancing mass lesion
Follow-up in ICP patients should be long enough to ensure a normalization of LFTs, and it is reasonable to check LFTs at 6 weeks
- If after 6 months there is no improvement, further specialist input will be required
ICP should settle spontaneously following delivery
The outcome of drug-induced cholestasis after withdrawal of the drug is generally good and few patients who develop DILI show abnormal liver tests and persistent histological evidence of liver damage at follow-up

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High dose comparable to lower doses of ACE inhibitors for heart failure

Jairia Dela Cruz, 16 Sep 2020

In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.