eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Cholestasis: Follow-up

Author: Karan M Emerick, MD, Consulting Staff, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Connecticut Children's Medical Center
Contributor Information and Disclosures

Updated: Jun 23, 2009

Follow-up

Further Inpatient Care

  • Follow-up care in patients with cholestasis is disease specific; therefore, refer to articles about disease states (see Causes).

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Cholestasis is not a disease but a symptom of a disease; therefore, it is a signal or marker that disease exists.
  • Cholestasis is never normal and should at all times be investigated for the underlying etiology.
  • Failure to investigate the cause of a patient's cholestasis may lead to the neglect of a progressive and significant disease process that will cause the patient harm.
  • Ignoring cholestasis or watching it progress without an understanding of the cause may be considered malpractice if avoidable harm to the patient occurs as a result.
 


More on Cholestasis

Overview: Cholestasis
Differential Diagnoses & Workup: Cholestasis
Treatment & Medication: Cholestasis
Follow-up: Cholestasis
Multimedia: Cholestasis
References
Further Reading
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References

  1. Poddar U, Thapa BR, Das A, Bhattacharya A, Rao KN, Singh K. Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country. Acta Paediatr. May 13 2009;[Medline].

  2. Strople J, Lovell G, Heubi J. Prevalence of Subclinical Vitamin K Deficiency in Cholestatic Liver Disease. J Pediatr Gastroenterol Nutr. Jun 3 2009;[Medline].

  3. Hutchin T, Preece MA, Hendriksz C, et al. Neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) as a cause of liver disease in infants in the UK. J Inherit Metab Dis. Jun 11 2009;[Medline].

  4. Mathias A, Wax JR, Pinette MG, Cartin A, Blackstone J. Progressive familial intrahepatic cholestasis complicating pregnancy. J Matern Fetal Neonatal Med. Jun 1 2009;1-3. [Medline].

  5. Shneider BL. Liver transplantation for progressive familial intrahepatic cholestasis: the evolving role of genotyping. Liver Transpl. Jun 2009;15(6):565-6. [Medline].

  6. Brough AJ, Bernstein J. Conjugated hyperbilirubinemia in early infancy. A reassessment of liver biopsy. Hum Pathol. Sep 1974;5(5):507-16. [Medline].

  7. [Guideline] Moyer V, Freese DK, Whitington PF, et al. Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. Aug 2004;39(2):115-28. [Medline]. [Full Text].

  8. [Guideline] Murray KF, Carithers RL Jr. AASLD practice guidelines: Evaluation of the patient for liver transplantation. Hepatology. Jun 2005;41(6):1407-32. [Medline]. [Full Text].

  9. Balistreri WF. Neonatal cholestasis. J Pediatr. Feb 1985;106(2):171-84. [Medline].

  10. Elferink RP, Groen AK. The mechanism of biliary lipid secretion and its defects. Gastroenterol Clin North Am. Mar 1999;28(1):59-74, vi. [Medline].

  11. Jones EA, Bergasa NV. The pruritus of cholestasis and the opioid system. JAMA. Dec 16 1992;268(23):3359-62. [Medline].

  12. Kaufman SS, Murray ND, Wood RP. Nutritional support for the infant with extrahepatic biliary atresia. J Pediatr. May 1987;110(5):679-86. [Medline].

  13. Oude Elferink RP, Paulusma CC, Groen AK. Hepatocanalicular transport defects: pathophysiologic mechanisms of rare diseases. Gastroenterology. Mar 2006;130(3):908-25. [Medline].

  14. Sabesin SM. Cholestatic lipoproteins--their pathogenesis and significance. Gastroenterology. Sep 1982;83(3):704-9. [Medline].

  15. Suchy FJ. Approach to the infant with cholestasis. In: Liver Disease in Children. 1st ed. St. Louis, Mo:. Mosby;1994:349-355.

  16. Trauner M, Meier PJ, Boyer JL. Molecular pathogenesis of cholestasis. N Engl J Med. Oct 22 1998;339(17):1217-27. [Medline].

  17. Whitington PF. Chronic cholestasis of infancy. Pediatr Clin North Am. Feb 1996;43(1):1-26. [Medline].

  18. Whitington PF, Whitington GL. Partial external diversion of bile for the treatment of intractable pruritus associated with intrahepatic cholestasis. Gastroenterology. Jul 1988;95(1):130-6. [Medline].

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Keywords

cholestasis, reduced bile formation, reduced bile flow, bile duct obstruction, cholestatic disorders, Dubin-Johnson syndrome, Rotor syndrome, Alagille syndrome, hyperchloremia, gram-negative sepsis, heart failure, metabolic disease, pruritus, itching, scratching, hyperlipidemia, xanthomas, xanthoma, failure to thrive, cholestatic liver disease, vitamin E deficiency, vitamin D deficiency, osteomalacia, rickets, biliary atresia, steatorrhea, scleral icterus, cutaneous jaundice, choledochal cyst, choledochal cyst, cholelithiasis, primary sclerosing cholangitis, hepatitis A, hepatitis B, hepatitis C, progressive familial intrahepatic cholestasis, treatment, diagnosis

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Contributor Information and Disclosures

Author

Karan M Emerick, MD, Consulting Staff, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Connecticut Children's Medical Center
Karan M Emerick, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

Medical Editor

Jayant Deodhar, MD, Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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