Which clinical history findings are characteristic of cholestasis?

Updated: Aug 09, 2017
  • Author: Hisham Nazer, MBBCh, FRCP, DTM&H; Chief Editor: Carmen Cuffari, MD  more...
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Patients with cholestasis may present clinically in many different ways depending on the disease process.

In most cases, scleral icterus is noted before any other sign; it may be apparent at conjugated bilirubin levels as low as 2 mg/dL.

At higher levels of conjugated bilirubin, dark urine may be noted secondary to the filtering of bilirubin into the urine. Cutaneous jaundice may not be noted until bilirubin levels reach 5 mg/dL or higher.

In patients with cholestasis, another common presentation is severe pruritus secondary to elevated bile acids. At high concentrations (5 times the reference range), retained bile acids can cause severe pruritus in which patients are unable to sleep or concentrate and may resort to cutaneous mutilation for relief.

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