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Copyright (c) 2025 Fatma Abdulaziz Al Eid, Hind Hassan Ali Homadi, Khadijah Ali Ali Awaji, Maram Ali Ali Awaji, Saad Mohammed Eid Al Modara, Nalahma Maghram Ahmed Aseri, Wadyah Ahmed Mohammed Yahya, Jameel Ahmed Mohammed Majrashi, Sameer Ali Ibrahim Zakri, Faisal Ali Ali Mujarrbi, Fahad Ali Ali Sharahili
This work is licensed under a Creative Commons Attribution 4.0 International License.
Cholestatic Jaundice in Nursing Practice, Clinical Laboratory Diagnostics, and General Internal Medicine: Assessment, Evaluation, and Multidisciplinary Management
Corresponding Author(s) : Fatma Abdulaziz Al Eid
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Cholestatic jaundice results from impaired bile formation or flow, leading to systemic retention of bilirubin and bile acids. It may arise from intrahepatic dysfunction or extrahepatic obstruction, each producing characteristic clinical, biochemical, and histopathological patterns. Its diverse etiologies—ranging from metabolic, infectious, inflammatory, obstructive, genetic, and drug induced disorders—necessitate comprehensive diagnostic evaluation.
Aim: To review the mechanisms, clinical presentation, diagnostic approach, and multidisciplinary management of cholestatic jaundice, emphasizing differentiation between intrahepatic and extrahepatic causes.
Methods: This review synthesizes pathophysiological concepts, epidemiology, histopathology, and clinical assessment, integrating laboratory, imaging, and biopsy based diagnostic strategies. Management approaches for both obstructive and hepatocellular cholestasis are examined, alongside therapeutic options for complications such as pruritus.
Results: Cholestatic jaundice presents with jaundice, pruritus, fat soluble vitamin deficiency, and biochemical patterns dominated by conjugated hyperbilirubinemia and elevated alkaline phosphatase. Ultrasonography and MRCP are central to distinguishing obstructive from non obstructive etiologies. Management of extrahepatic obstruction relies on biliary decompression through ERCP, stenting, or surgery, while hepatocellular cholestasis requires treatment of underlying causes and symptom directed therapy. Refractory pruritus may require second line pharmacologic or procedural interventions.
Conclusion: Cholestatic jaundice is a multifactorial clinical syndrome requiring early recognition, structured diagnostic assessment, and coordinated multidisciplinary management. Timely intervention reduces hepatic injury, prevents complications, and improves patient outcomes.
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- Hasan MS, Karim AB, Rukunuzzaman M, Haque A, Akhter MA, Shoma UK, Yasmin F, Rahman MA. Role of Liver Biopsy in the Diagnosis of Neonatal Cholestasis due to Biliary Atresia. Mymensingh Med J. 2018 Oct;27(4):826-833.
- Nunes TF, Tibana TK, Santos RFT, de Faria BB, Marchiori E. Percutaneous transhepatic cholangiobiopsy. Radiol Bras. 2019 Jan-Feb;52(1):41-42.
- Chen HL, Wu SH, Hsu SH, Liou BY, Chen HL, Chang MH. Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases. J Biomed Sci. 2018 Oct 26;25(1):75.
- Fargo MV, Grogan SP, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician. 2017 Feb 01;95(3):164-168.
- Hilscher MB, Kamath PS, Eaton JE. Cholestatic Liver Diseases: A Primer for Generalists and Subspecialists. Mayo Clin Proc. 2020 Oct;95(10):2263-2279.
- Feldman AG, Sokol RJ. Neonatal Cholestasis: Updates on Diagnostics, Therapeutics, and Prevention. Neoreviews. 2021 Dec 01;22(12):e819-e836.
- Liu X, Xu B, Zeng Y, Chen P, Wang Y. Case report: Severe cholestatic jaundice associated with hyperthyroidism treated with methimazole. Medicine (Baltimore). 2023 Nov 10;102(45):e35972.
- Robie DK, Overfelt SR, Xie L. Differentiating biliary atresia from other causes of cholestatic jaundice. Am Surg. 2014 Sep;80(9):827-31.
- Siddiqui AI, Ahmad T. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Biliary Atresia.
- Fricker ZP, Lichtenstein DR. Primary Sclerosing Cholangitis: A Concise Review of Diagnosis and Management. Dig Dis Sci. 2019 Mar;64(3):632-642.
- Zhu Y, Wang S, Zhao S, Qi L, Li Z, Bai Y. Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature. BMC Gastroenterol. 2018 Nov 03;18(1):163.
- Gunaydin M, Bozkurter Cil AT. Progressive familial intrahepatic cholestasis: diagnosis, management, and treatment. Hepat Med. 2018;10:95-104.
- Dasari BVM, Ionescu MI, Pawlik TM, Hodson J, Sutcliffe RP, Roberts KJ, Muiesan P, Isaac J, Marudanayagam R, Mirza DF. Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta-analysis. J Surg Oncol. 2018 Sep;118(3):477-485.
- Madhani K, Farrell JJ. Management of Autoimmune Pancreatitis. Gastrointest Endosc Clin N Am. 2018 Oct;28(4):493-519.
- Vandenabeele LAM, Dhondt E, Geboes KP, Defreyne L. Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options. Acta Gastroenterol Belg. 2017 Apr-Jun;80(2):249-255.
- Smith SE. Management of Acute Cholangitis and Choledocholithiasis. Surg Clin North Am. 2024 Dec;104(6):1175-1189.
- An Z, Braseth AL, Sahar N. Acute Cholangitis: Causes, Diagnosis, and Management. Gastroenterol Clin North Am. 2021 Jun;50(2):403-414.
- Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol. 2023 Jan;20(1):26-36.
References
Hasan MS, Karim AB, Rukunuzzaman M, Haque A, Akhter MA, Shoma UK, Yasmin F, Rahman MA. Role of Liver Biopsy in the Diagnosis of Neonatal Cholestasis due to Biliary Atresia. Mymensingh Med J. 2018 Oct;27(4):826-833.
Nunes TF, Tibana TK, Santos RFT, de Faria BB, Marchiori E. Percutaneous transhepatic cholangiobiopsy. Radiol Bras. 2019 Jan-Feb;52(1):41-42.
Chen HL, Wu SH, Hsu SH, Liou BY, Chen HL, Chang MH. Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases. J Biomed Sci. 2018 Oct 26;25(1):75.
Fargo MV, Grogan SP, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician. 2017 Feb 01;95(3):164-168.
Hilscher MB, Kamath PS, Eaton JE. Cholestatic Liver Diseases: A Primer for Generalists and Subspecialists. Mayo Clin Proc. 2020 Oct;95(10):2263-2279.
Feldman AG, Sokol RJ. Neonatal Cholestasis: Updates on Diagnostics, Therapeutics, and Prevention. Neoreviews. 2021 Dec 01;22(12):e819-e836.
Liu X, Xu B, Zeng Y, Chen P, Wang Y. Case report: Severe cholestatic jaundice associated with hyperthyroidism treated with methimazole. Medicine (Baltimore). 2023 Nov 10;102(45):e35972.
Robie DK, Overfelt SR, Xie L. Differentiating biliary atresia from other causes of cholestatic jaundice. Am Surg. 2014 Sep;80(9):827-31.
Siddiqui AI, Ahmad T. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Biliary Atresia.
Fricker ZP, Lichtenstein DR. Primary Sclerosing Cholangitis: A Concise Review of Diagnosis and Management. Dig Dis Sci. 2019 Mar;64(3):632-642.
Zhu Y, Wang S, Zhao S, Qi L, Li Z, Bai Y. Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature. BMC Gastroenterol. 2018 Nov 03;18(1):163.
Gunaydin M, Bozkurter Cil AT. Progressive familial intrahepatic cholestasis: diagnosis, management, and treatment. Hepat Med. 2018;10:95-104.
Dasari BVM, Ionescu MI, Pawlik TM, Hodson J, Sutcliffe RP, Roberts KJ, Muiesan P, Isaac J, Marudanayagam R, Mirza DF. Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta-analysis. J Surg Oncol. 2018 Sep;118(3):477-485.
Madhani K, Farrell JJ. Management of Autoimmune Pancreatitis. Gastrointest Endosc Clin N Am. 2018 Oct;28(4):493-519.
Vandenabeele LAM, Dhondt E, Geboes KP, Defreyne L. Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options. Acta Gastroenterol Belg. 2017 Apr-Jun;80(2):249-255.
Smith SE. Management of Acute Cholangitis and Choledocholithiasis. Surg Clin North Am. 2024 Dec;104(6):1175-1189.
An Z, Braseth AL, Sahar N. Acute Cholangitis: Causes, Diagnosis, and Management. Gastroenterol Clin North Am. 2021 Jun;50(2):403-414.
Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol. 2023 Jan;20(1):26-36.