Last updated: Friday, 19, November, 2010
CausesAppropriate Tests

Differentiation between intra- and extra-hepatic cholestasis is made by clinical assessment and, as appropriate, diagnostic imaging.

Significant cholestasis may exist without jaundice being apparent.

ALP, GGT, AST, ALT (AST/ALT ratio), LD, bilirubin; PT; FBC.

Liver biopsy, (FNAB), if appropriate.


  • Hepatic metastases
  • Cholangiocarcinoma
  • Pancreatic carcinoma
See under Pancreatic neoplasm.

Gall stones

Primary sclerosing cholangitis

Post-operative stricture

Primary biliary cirrhosis

Mitochondrial antibodies, immunoglobulins G, A, M. Marked elevation of IgM is suggestive of primary biliary cirrhosis.

Cystic fibrosis

Helminth infection, including

Faeces - ova, cysts and parasites. Identification of fluke found at operation.
  • Fasciola hepatica
Fasciola hepatica antibodies are of value for establishing the diagnosis and for monitoring treatment.
  • Clonorchis sinensis

Biliary atresia

Cholestasis of pregnancy (oestrogen related)

Drug-induced cholestasis

  • Oestrogen
  • Phenothiazines
  • Flucloxacillin
  • Amoxycillin/Clavulanate
  • Anabolic steroids
  • Erythromycin estolate

Granulomatous Hepatitis



Infection, especially

  • Brucellosis
  • Tuberculosis
  • Q fever

Genetic cholestasis

  • Dubin Johnson syndrome
Liver biopsy; porphyrins - urine.
  • Rotor syndrome
Liver biopsy.
  • Bile acid synthetic defects
Bile acids - specialised laboratory.

Hepatocellular disease, especially 

Primary hepatocellular disorders often have a cholestatic component.
  • Hepatitis




Biliary colic

Ascending cholangitis

Blood culture.

Malabsorption, especially 

  • Vitamin K deficiency
  • Osteomalacia

Biliary cirrhosis