Cholestasis is a condition characterized by the impaired flow of bile(a digestive fluid produced by the liver), from the liver to the small intestine. This impairment can occur at any point along the bile ducts, leading to a buildup of bile in the liver. Cholestasis can be either intrahepatic (occurring within the liver) or extrahepatic (occurring outside the liver).
• Itching: Pruritus, or severe itching, is one of the hallmark symptoms of cholestasis. It is often more pronounced on the palms of the hands and soles of the feet.
• Jaundice: Cholestasis can cause a yellowing of the skin and eyes due to the accumulation of bilirubin, a yellow pigment produced when red blood cells break down.
• Pale stools and dark urine: Since bile is responsible for giving stool its characteristic brown color, a reduction in bile flow can result in pale or clay-colored stools. Conversely, the bilirubin buildup can darken the urine.
• Gallstones: These can obstruct the bile ducts, leading to cholestasis.
• Liver diseases: Conditions such as hepatitis, cirrhosis, or primary biliary cholangitis can cause intrahepatic cholestasis.
• Medications: Certain drugs, such as some antibiotics, antifungals, and hormonal therapies, can cause cholestasis as a side effect.
• Pregnancy: Intrahepatic cholestasis of pregnancy is a specific form of cholestasis that occurs during pregnancy, usually in the third trimester.
Risk factors –
• Female gender: Cholestasis is more common in women than men.
• Pregnancy: As mentioned earlier, intrahepatic cholestasis of pregnancy is a specific form associated with pregnancy.
• Family history: There may be a genetic predisposition to developing cholestasis.
• Certain medical conditions: Conditions such as autoimmune diseases and cystic fibrosis can increase the risk of cholestasis.
• Malabsorption of fat-soluble vitamins: The reduced flow of bile can interfere with the absorption of vitamins A, D, E, and K, leading to deficiencies.
• Nutritional deficiencies: Cholestasis can hinder the absorption of essential nutrients, causing malnutrition.
• Liver damage: Prolonged cholestasis can result in liver cell injury, inflammation, and, in severe cases, cirrhosis.
To diagnose cholestasis, healthcare providers may perform various tests, including
• Blood tests to measure liver function
• Imaging studies to evaluate the bile ducts
• A liver biopsy to assess the extent of liver damage.
Treatment of cholestasis focuses on relieving symptoms and addressing the underlying cause. Depending on the severity and underlying condition, treatment options may include:
• Medications: Certain medications can help improve bile flow and relieve symptoms.
• Ursodeoxycholic acid (UDCA): This medication is commonly prescribed to reduce bile acid levels and alleviate itching.
• Surgical intervention: In cases of extrahepatic cholestasis caused by gallstones, surgery to remove the obstruction may be necessary.
• Symptom management: Itching can be managed with antihistamines, cholestyramine, or other prescribed medications.
Ayurvedic Perspective –
In Ayurveda, cholestasis is understood as an imbalance in the “Pitta” and “Kapha” doshas, particularly the subdosha called “Pachaka Pitta” and the “Meda Dhatu” (fat tissue). From an Ayurvedic perspective, the primary aim of treatment is to balance the aggravated doshas, restore the flow of bile, and improve liver function.
Here are some Ayurvedic treatments and remedies that may be used for cholestasis:
• Diet and Lifestyle:
It is important to follow a Pitta and Kapha balancing diet. This includes consuming fresh, organic fruits and vegetables, whole grains, legumes, and lean proteins. Avoid spicy, oily, and fried foods. Regular exercise, stress management techniques like yoga and meditation, and adequate sleep are also recommended.
• Herbal Remedies:
Several herbs are known to be beneficial for liver health and bile flow. These include:
▪︎ Bhumyamalaki (Phyllanthus niruri): Supports liver function and helps improve bile flow.
▪︎ Kutki (Picrorhiza kurroa): Enhances liver detoxification and promotes bile secretion.
▪︎ Punarnava (Boerhavia diffusa): Supports liver health and reduces inflammation.
▪︎ Guduchi (Tinospora cordifolia): Boosts immunity and aids in liver regeneration.
These herbs are often prescribed in the form of powders, tablets, or decoctions.
Ayurvedic detoxification therapies known as Panchakarma can be beneficial for cholestasis. These therapies help eliminate toxins from the body, balance the doshas, and improve liver function. Some Panchakarma treatments that may be recommended include Virechana (therapeutic purgation) and Basti (medicated enema).
• Yoga and Pranayama:
Practicing yoga asanas and pranayama (breathing exercises) can be beneficial for overall liver health. Specific yoga postures like Ardha Matsyendrasana (Half Spinal Twist) and Bhujangasana (Cobra Pose) may help stimulate the liver and improve digestion.
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