Gall stasis – symptoms, diagnosis and therapy

Anyone who has ever suffered from gallstones may also be familiar with gall stasis (cholestasis). This occurs because of this suffering. However, other health problems can also lead to cholestasis under certain conditions. In this article, you will learn all the important details about the development, possible causes and treatment of gall stasis.

contents

• definition
• Gallstones as the main cause
• Cholestasis in biliary disorders
• Liver disease and biliary congestion
• Cholestasis from blood and vascular diseases
• Risk factor: 5xF
• Symptoms
  • Pain
  • Jaundice
• diagnosis
• therapy
  • surgery
  • Medical therapy
  • Home remedies
  • Naturopathy and other measures
• Possible diseases with a gall stasis

definition

Our gallbladder (Vesica biliaris) is essential for trouble-free digestion. This is where the bile juice (bilis) formed by the liver is stored and thickened before it is fed into the duodenum for digestion as needed. As a result, if we eat particularly greasy food, more bile juice from the gallbladder’s memory will be needed. In order to carefully break down the fat molecules of food that is consumed, the bile juice consists of various additives that allow fat lipids to be emulsified. The main components are:

• Water– makes up about 82 percent of the bile juice and determines its liquid consistency.
• Bile salts / bile acids– about twelve percent contained in bile juice and responsible for the emulsification of fats in the intestine; they also make it easier for digestive enzymes to break down food.
• Phospholipids– Phospholipids such as lecithin are found in the bile juice with a share of up to four percent and are also involved in the breakdown of dietary fats. In detail, phospholipids help convert the fat droplets so that they can be metabolized by the body.

Gall stasis often occurs in conjunction with gallstone disease, but other health problems can also lead to cholestasis. (Image: PIC4U / fotolia.com)

Also contained in the bile are small amounts of cholesterol and the bile pigments bilirubin and biliverdin. The latter arise in the liver from the breakdown of the red blood pigment (hemoglobin) and are temporarily stored in the bile juice until they are eliminated from the body. The bile pigments give it its brownish color, which results from the mixture of red bilirubin and green biliverdin.

In the case of a gall stasis, there is now a reduced, if not completely blocked, forwarding of all of the above-mentioned biliary supplements. The bile juice can therefore only be passed on to the intestine insufficiently or not at all, which logically massively affects fat digestion. Depending on the respective mechanism of origin, a cholestasis can be divided into two different forms:

1. Extrahepatic Cholestasis:
   Extrahepatic means something like “outside the liver”. From this it can be deduced that the causes of extrahepatic cholestasis are usually not found in the liver. There are usually mechanical impairments of the bile flow, as is the case, for example, with a blockage of the bile ducts by gallstones.
2. Intrahepatic cholestasis:
   As a counterpart to the extrahepatic biliary congestion,intrahepatic cholestasis describes those forms of the clinical picture that are based on causes “within the liver”. As a result, liver problems lead to backflow of the bile. For example, liver diseases such as hepatitis or liver poisoning from excessive alcohol consumption are conceivable.

Gall stasis is often due to existing gallstone disease. (Image: Henrie / fotolia.com)

Gallstones as the main cause

As already mentioned, gall stasis is very often due to existing gallstone disease (cholelithiasis). The gallstones arise from a material imbalance in the composition of the bile. An excess of solid substances – mainly bile salts – often provokes first a bile semolina, which means the viscous thickening of the bile juice due to too many solid components. This is followed by the failure of salt crystals, which gradually condense into a gall stone.

At the beginning, the gallstones are still very small and initially remain in the gallbladder. In the further course, these so-called cholelites can detach and migrate into the bile ducts, where they then block the transport of substances. If gallstones are responsible for gall stasis, this is called extrahepatic cholestasis.

Cholestasis in biliary disorders

Some other extrahepatic causes of gall stasis are hidden behind serious diseases of the gall bladder. Inflammation of the bile duct (cholangitis) is conceivable, for example, in which inflammation causes swelling in the area of ​​the bile ducts. The bile fluid can no longer be drained without problems, which ultimately results in the bile congestion. The situation is similar with inflammation of the gallbladder (cholecystitis), whereby blockages are more likely to occur at the portal area of ​​the biliary tract.

Both cholangitis and cholecystitis are based on gallstone disease in about 90 to 95 percent of all cases. However, a tumor can also trigger the blockade. Even more, tumor diseases such as bile duct carcinoma are able to independently trigger cholestasis. A third cause associated with narrowing of the bile ducts is also scarred bile tissue. This occurs, for example, as part of biliary tract surgery.

Liver disease and biliary congestion

The possible causes of cholestasis are diverse, even with intrahepatic forms. Above all, it is the inflammation of the liver (hepatitis) that repeatedly causes bile congestion. Especially in the advanced stage, hepatitis affects the formation of bile in the liver. This is all the more likely if viral hepatitis is caused by:

• Adenoviruses,
• Enteroviruses,
• Epstein-Barr viruses,
• Herpes viruses,
• Mumps viruses,
• Rubella viruses,
• Varicella zoster viruses
• or yellow fever viruses

is present. The virus infection has a massive effect on the secretion formation of the bile juice, which subsequently becomes more viscous and, in addition to a backflow of bile, can also contribute to the formation of gallstones. A liver tumor (hepatic hemangioma) is also conceivable as a trigger for cholestasis. As with bile duct carcinoma, the transport route from the bile to the gallbladder is hampered by tumor-related narrowing, which causes the backflow of the bile.

Some other disorders in the transport of bile from the liver to the gallbladder can be derived from the unfavorable influence of the substance. Alcohol, but also drugs and toxins often contribute to altered or disturbed secretion in the liver. At the same time, the substances can also cause liver swelling and liver enlargement due to irritation.

Space-consuming body processes such as pregnancy can also cause gall stasis. (Image: drubig-photo / fotolia.com)

In addition, space-consuming body processes such as pregnancy cannot be excluded as a cause. Here it is the steadily growing unborn child that may press on the liver and thus obstruct the bile flow.

Cholestasis from blood and vascular diseases

Speaking of pregnancy: there is occasional gall stasis in newborns too. The cause in these cases is usually due to the child’s blood group intolerance, which can later lead to increased bilirubin secretion and thrombosis in the area of ​​the bile vessels. In general, thrombosis in the biliary and liver areas is another health complaint, which can contribute to the narrowing or the complete closure of the biliary tract.

Risk factor: 5xF

A special risk group is formed by a special type of woman, which is also called “5xF” in medical jargon. The term is derived from the English terms for the five properties that are assigned to this risk group, namely:

1. female,
2. fair hair,
3. fertile (fertile),
4. overweight (fat),
5. around 40 years old (forty).

It has not yet been completely clarified why these patients suffer from gall stasis relatively often. However, it can be assumed that, on the one hand, the special menopausal hormone levels of women in their 40s play a role in bile secretion and in the remodeling of bile and liver tissue. On the other hand, genetic peculiarities of light-colored hair and skin types as well as the challenge of digesting fat if you are overweight also seem to play a role in the problem.

A gall stasis can also hide behind very unspecific complaints, such as nausea, for a long time. (Image: terovesalainen / fotolia.com)

Symptoms

A gall stasis usually manifests itself in a number of specific symptoms. However, it can very often be that if the course is gradual, he initially hides behind very unspecific complaints for a while, but this often occurs specifically after eating certain (predominantly high-fat) foods. These non-specific complaints include:

• Nausea,
• Upper abdominal pressure,
• Feeling of fullness,
• Flatulence (meteorism),
• Slight feverishness up to 38 ° C,
• Weariness,
• Diarrhea.

In most cases, these symptoms appear repeatedly after a lavish meal and resolve themselves within a few hours. This is also the reason for the risk of biliary congestion: Often these symptoms only unmask themselves as manifest biliary problems and become more specific symptoms when the body is in an acute situation due to the biliary congestion and one of the possible complications such as for example, a biliary colic, inflammation, an impending perforation, a gall bladder abscess or even the onset of liver failure.

The specific symptoms of a gall stasis then appear very suddenly and often lead to a very drastic, stressful and, above all, fear-triggering situation for those affected. The symptoms that are characteristic of a gall stasis are explained in more detail below:

Pain

The unspecific and quickly subsiding upper abdominal discomfort escalates to violent, cramp-like pain in the upper and middle abdomen, which can radiate into the back and the right shoulder . These painful conditions, known as biliary colic, often occur in combination with vegetative side effects such as sweating, nausea , vomiting and impending circulatory collapse with increased heart rate ( tachycardia ), low blood pressure ( hypotension ) and increased breathing (tachypnea). In very serious cases, the pain situation can expand into an acute abdomen, which is manifested in a tight abdominal wall and a defensive tension.

Jaundice

Due to the backlog of bile pigments, cholestasis can lead to a pale discolored stool and an accumulation of bilirubin and biliverdin in the body tissue. The resulting complaint of jaundice (jaundice) is therefore very often an indication of existing disorders in bile transport.

Due to the biliary congestion, the bile can no longer flow into the intestine and accumulates back into the liver pathways. As a result, the blood breakdown product bilirubin produced in the liver can no longer be released into the bile in the required amount and passes into the blood. With normal blood flow, the bilirubin is now distributed in the body in an unusually high concentration and passes into the tissue, which leads to a variety of well-observable symptoms:

• Yellowing of the skin in connection with severe itching,
• Yellowing of the white dermis of the eyes (scleral icterus),
• Discolored bowel movements (light yellow to white),
• (dark) brown discoloration of the urine.

Warning: In very serious cases, the liver may also be restricted in its function due to problems with the bile. This can result in disturbances in blood coagulation (noticeable by an increased tendency to bleed) and in the protein balance (noticeable by increased edema in the area of ​​the trunk and extremities )!

diagnosis

Biliary stasis is sometimes only diagnosed by chance during ultrasound examinations of the abdominal cavity, which were actually carried out with a different focus. This coincidental finding often occurs when bile stones cause bile congestion.

If a biliary congestion is suspected to be the cause of the symptoms, doctors will carry out an ultrasound examination of the abdomen to support the suspected diagnosis. (Image: Elnur / fotolia.com)

If a doctor suspects a biliary congestion as the cause of the symptoms of the affected person, an ultrasound examination of the abdominal cavity is carried out to support the suspected diagnosis. Possible causes of gall stasis can also be assessed. For example, gallstones can usually be assessed very well sonographically and their quality and size can be defined.

If a thickened gallbladder wall can be visualized, this is a clear sign of an inflammatory process taking place in the gallbladder. A possible involvement of the liver can also be determined in the context of an ultrasound examination.

Since the symptoms of a gall stasis theoretically allow other diagnoses, these should be excluded by further diagnostics. The following examinations are available for this:

To support the diagnosis, the doctor will also carry out laboratory chemical tests on the blood. Typically, the inflammation values ​​(CRP, sedimentation rate, small blood count), the bilirubin values ​​(direct and indirect bilirubin) and the liver values ​​(GOT, GGT, GPT, alkaline phosphatase) are determined. If doctors suspect a tumor as the cause of the gall stasis, they will have a CT scan carried out to find the locations of other ulcers. In this case, prior to an adapted therapy, samples could also be taken from the internal organs.

therapy

Since the possible causes of a gall stasis are very different, doctors have to decide on a case-by-case basis which therapeutic measures are expedient. In most cases, an operation cannot be avoided. Be it that gallstones or even organ sections of the liver or bile have to be removed in order to improve the patient’s condition. In addition, medicinal and medicinal measures or home remedies are available to alleviate the symptoms.

surgery

Cholestasis is almost always an event that ultimately requires surgery. In the case of gallstone disease, various surgical methods are available.

Endoscopic extraction of gallstones, also called endoscopic retrograde choliangiopancreatography (ERCP for short) is conceivable. The procedure can already be used during diagnosis and, after endoscopic examination of the gallbladder and biliary tract, allows the stones to be removed with the appropriate instruments. Before removal, the bile ducts must first be inflated by a balloon and thus artificially expanded. Endoscopy can also be used to insert a catheter through which the gall stone is later derived.

There are several ways to remove gallstones. They can be removed, among other things, by means of endoscopic extraction or broken up using extracorporeal shock wave lithotripsy. (Image: jozsitoeroe / fotolia.com)

An alternative treatment for stone removal is extracorporeal shock wave lithotripsy (ESWL for short), in which the gallstones are crushed using shock waves. However, there is a high risk that residues of broken stones will remain in the gallbladder and that stone disease will flare up again after a few years.

Affected people who often suffer from gallstones or biliary problems in general, or who have a serious tumor disease, will sooner or later face a surgical removal of the gallbladder (cholecystectomy). This can be done in two ways:

1. Cholecystectomyusing a laparoscope – The gallbladder is removed using a keyhole principle through several small holes in the abdominal wall.
2. Cholecystectomy by laparotomy– the gallbladder is removed via an abdominal incision.

As a rule, preference is given to a laparoscopic removal, since this procedure is associated with a quick recovery time for the person concerned and is less stressful for him. However, if the doctors face major complications, a laparotomy may have to be performed, which means that the gallbladder is not surgically removed (cholecystectomy).

Although biliary stasis can be treated conservatively and also supportive with natural approaches, cholestasis is a disease that is very often associated with a so-called boomerang effect. Those affected will in all likelihood be repeatedly confronted with the symptoms of a gall stasis, at ever shorter intervals and with increasing severity. This also increases the complication rate, which can even be life-threatening in some cases. That is why nowadays one has started to operate very quickly in case of problems with bile. Especially in view of the fact that a cholecystectomy is a very simple operation with a low complication rate and a quick recovery time for those affected in non-life-threatening circumstances.

Medical therapy

Gallstones as the cause of the gall stasis can also be removed using litholysis. Special medicinal products based on ursodeoxycholic acid or chenodeoxycholic acid are administered. The active ingredients dissolve the stones in the body, which can then be easily excreted. However, the rate of recurrence in litholysis is similar to that in stone crushing. This applies especially to gallstones that are larger than five millimeters, which is why the medicinal procedure is mostly only used for very small stones.

For cancer of the liver or gall bladder, a combination of surgery and radiation or chemotherapy is used where possible. For this purpose, the tumor is first irradiated for some time or treated with chemotherapy drugs such as fuorouracil, cisplatin or irnotecan in order to reduce it. After that, surgeons perform an operation that ideally completely removes the tumor tissue. If this is not possible, complete removal of the affected organ may also be necessary to prevent the cancer cells from spreading.

If they have acute symptoms, doctors will first try to control the symptoms with medication. (Image: motortion / fotolia.com)

If affected people with acute complaints go to a doctor, they will under no circumstances order an operation immediately, but first try to get the symptoms under control with medication. The same applies to biliary or liver inflammation, which can also be treated with medication to a limited extent. Medicines with different starting points are available here:

• Pain:
  Various pain relievers are available to relieve the pain. In view of an upcoming operation, however, painkillers that also have a blood-thinning effect, such as ASA or aspirin, should be avoided. Novalgin, ibuprofen and metamizole are therefore the drugs of choice.
• Cramps:
  The pain is very often accompanied by severe cramps in the abdomen. These can be treated very well with the antispasmodic Buscopan. This medication can be administered as a tablet, in suppositories or through the vein.
• Inflammation:
  A common complication of cholestasis is inflammation. In order to be able to control them, an antibiotic is often administered. Sometimes antibiotic therapy is started purely prophylactically even in the absence of signs and parameters of inflammation.

As long as there is no danger to life, those affected are treated symptomatically until their general condition is compatible with surgery. This approach has proven itself to reduce the risk of possible complications that can be associated with surgery.

Home remedies

Affected people can also work themselves with existing biliary congestion and actively support both the acute phase of the biliary congestion with its symptoms and the healing process after an operation.

• Acute phase with various
  problems with the bile:The medication therapy regime of the doctors can be supported by a lack of food (only drinking sips of still water or unsweetened herbal teas), bed rest, warm stomach wraps and close monitoring of the body temperature (indication of the inflammatory process).
• After the operation:
  After a successful operation, those affected can still experience bloating, flatulence and diarrhea up to six months later. This can be seen as an indication that the body has not yet fully adapted to the new condition and is responding to certain foods or to copious meals with these symptoms. A change in diet and diet can help here. In general, a low-fat and high-fiber diet is often recommended in connection with biliary disorders. However, those affected can also simply test for themselves which foods are good for them and which they should simply avoid in the future.

There are some products from naturopathy that help with bile problems, such as the student salts number 7 and 10. (Image: Gerhard Seybert / fotolia.com)

Naturopathy and other measures

In the phase of acute symptoms you can support the body with some Schüßler salts and homeopathic remedies. In the case of severe pain, the Schüßler Salt No. 7 can be used several times a day as “hot sieves” to relieve the pain. And Schuessler Salt No. 10 is said to stimulate the bile flow. In the field of homeopathy, the following preparations can be used in connection with biliary problems:

• Nux vomica (if you feel full after eating, upper abdominal discomfort),
• Berberis (for colic, for detoxification),
• Carduus marianus (milk thistle, the “liver and biliary agent” par excellence),
• Chelidonium (for pain).

Dietary support can also be used to support bile problems through the frequent use of certain medicinal plants and herbs. The medicinal plants have two different starting points:

Lowering cholesterol as a building material that can lead to gallstones:

• A glass of water with one or two tablespoons of lemon juice or apple cider vinegar (once or twice a day).
• One to two tablespoons of psyllium husk(in muesli or smoothie or pure, once or twice a day).

Diet can help with bile problems, for example psyllium husk has a cholesterol-lowering effect. (Image: farfalla2017 / fotolia.com)

Strengthening liver health and promoting biliary juice excretion:

• Dandelion salad,
• Peppermint tea, yarrow tea,
• Beetroot and artichoke to accompany a meal,
• Use of the turmeric spice.

Possible diseases with a gall stasis

• Gallstones,
• Gallengries,
• Bile duct inflammation,
• Gallbladder inflammation,
• Bile duct carcinoma,
• Hepatitis,
• Liver hemangioma,
• Liver poisoning,