The key difference between intrahepatic and extrahepatic cholestasis is that intrahepatic cholestasis is due to an impairment of bile formation, while extrahepatic cholestasis is due to an impedance to bile flow after its formation.
The liver produces bile and delivers it to the digestive system through a network of vessels called bile ducts. Cholestasis is a condition due to the slowing down of bile flow from the liver. Therefore, intrahepatic cholestasis and extrahepatic cholestasis are two different cholestasis.
CONTENTS
1. Overview and Key Difference
2. What is Intrahepatic Cholestasis
3. What is Extrahepatic Cholestasis
4. Similarities – Intrahepatic and Extrahepatic Cholestasis
5. Intrahepatic vs. Extrahepatic Cholestasis in Tabular Form
6. FAQ – Intrahepatic and Extrahepatic Cholestasis
7. Summary – Intrahepatic vs. Extrahepatic Cholestasis
What is Intrahepatic Cholestasis?
Intrahepatic cholestasis is a type of cholestasis that is due to an impairment of bile formation. Intrahepatic cholestasis can be caused by numerous reasons, such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), drugs and toxins, sepsis, malignancy granulomatous liver disease (infections, chemicals, drugs and miscellaneous), pregnancy-related complications, genetic disorders, total parenteral nutrition-associated cholestasis, graft versus host disease, and post-liver transplant cholestasis. Moreover, the symptoms of intrahepatic cholestasis may include severe itching, dark urine or light-coloured bowel movements, jaundice, loss of appetite, nausea, or pain in the upper right belly.
Figure 01: Intrahepatic Cholestasis
Intrahepatic cholestasis can be diagnosed through medical history, physical examination, and blood tests. Furthermore, treatment options for intrahepatic cholestasis may include managing the underlying condition and giving ursodeoxycholic acid.
What is Extrahepatic Cholestasis?
Extrahepatic cholestasis is a type of cholestasis due to an impedance to bile flow after its formation. Extrahepatic cholestasis can be caused by choledocholithiasis, bile duct tumors, ampullary tumors (benign and malignant), pancreatic carcinoma, Mirizzi’s syndrome, AIDS cholangiopathy, parasites, and PSC (primary sclerosing cholangitis). The symptoms of extrahepatic cholestasis may include jaundice, dark urine, light-coloured stool, pain in the abdomen, fatigue, nausea, and excessive itching.
Figure 02: Extrahepatic Cholestasis
Extrahepatic cholestasis can be diagnosed through medical history, physical examination, blood test, and imaging tests such as MRI scan and liver biopsy. Furthermore, extrahepatic cholestasis is treated by managing underlying causes, giving recommended drugs such as ursodiol (Actigall, Urso, Urso Forte) and anti-itching medicines like antihistamines, and recommended surgery.
What are the Similarities Between Intrahepatic and Extrahepatic Cholestasis?
- Intrahepatic cholestasis and extrahepatic cholestasis are two different forms of cholestasis.
- Both types can have similar symptoms, such as itching, dark urine, light-colored stool, etc.
- Both types can be diagnosed through medical history, physical examination, and blood tests.
- They can be treated through medicines such as ursodeoxycholic acid.
What is the Difference Between Intrahepatic and Extrahepatic Cholestasis?
Intrahepatic cholestasis is due to an impairment of bile formation, while extrahepatic cholestasis is due to an impedance to bile flow after its formation. Thus, this is the key difference between intrahepatic and extrahepatic cholestasis. Furthermore, intrahepatic cholestasis can be caused by primary biliary cirrhosis, primary sclerosing cholangitis, drugs and toxins, sepsis, malignancy-granulomatous liver disease, pregnancy-related complications, genetic disorders, total parenteral nutrition-associated cholestasis, graft versus host disease and post-liver transplant cholestasis. On the other hand, extrahepatic cholestasis can be caused by choledocholithiasis, bile duct tumors, ampullary tumors, pancreatic carcinoma, Mirizzi’s syndrome, AIDS cholangiopathy, parasites, and primary sclerosing cholangitis.
The infographic below presents the differences between intrahepatic and extrahepatic cholestasis in tabular form for side-by-side comparison.
FAQ: Intrahepatic and Extrahepatic Cholestasis
How do you diagnose extrahepatic cholestasis?
Ultrasound and liver biopsy are two ways of diagnosing cholestasis.
What is the most common cause of cholestasis?
Liver diseases are the most common cause of cholestasis.
How is intrahepatic cholestasis treated?
Ursodeoxycholic Acid medication is used as the first-line treatment for the treatment of intrahepatic cholestasis.
Summary – Intrahepatic vs. Extrahepatic Cholestasis
Cholestasis is a liver disease that occurs when the flow of bile from the liver is reduced or blocked. There are two forms of cholestasis: intrahepatic cholestasis and extrahepatic cholestasis. Intrahepatic cholestasis is a type of cholestasis due to an impairment of bile formation. It can be caused by disease, infection, drug use, genetic abnormalities, hormonal effects, and pregnancy. Extrahepatic cholestasis is a type of cholestasis due to an impedance to bile flow after its formation. It can be caused by blockages of bile ducts from things like gallstones, cysts, and tumors that restrict the flow of bile. So, this summarizes the difference between intrahepatic and extrahepatic cholestasis.
Reference:
1. “Pregnancy Intrahepatic Cholestasis.” Statpearls – NCBI Bookshelf.
Image Courtesy:
1. “Cholestasis 2 intermed mag” By Nephron – Own work (CC BY-SA 3.0) via Commons Wikimedia
2. “Sickle cell disease and cirrhosis – intermed mag” By Nephron – Own work (CC BY-SA 3.0) via Commons Wikimedia