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Wiener klinische Wochenschrift Education

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01.08.2014 | DFP-Fortbildung

Cholestase – Update 2014

verfasst von: Gernot Zollner, Michael Trauner

Erschienen in: Wiener klinische Wochenschrift Education | Ausgabe 3-4/2014

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Cholestase ist als Reduktion oder völliges Sistieren des Galleflusses bzw. der Gallesekretion definiert. Dies bewirkt die Retention gallepflichtiger Substanzen wie Gallensäuren, konjugiertem Bilirubin und Cholesterin und hat Müdigkeit, Pruritus und Ikterus zur Folge. Cholestase kann nach der Pathogenese in mechanische (obstruktive) und nicht mechanische Cholestaseformen eingeteilt werden oder als intrahepatische und extrahepatische Cholestase klassifiziert werden. Die intrahepatische Cholestase ist zumeist die Folge funktioneller sekretorischer Defekte auf Ebene der Hepatozyten. Sie kann aber auch durch eine mechanische Obstruktion distal der Gallekanalikuli in den intrahepatischen Gallenwegen bedingt sein (z. B. durch intrahepatische Tumore oder Metastasen, Strikturen intrahepatischer Gallenwege bei sklerosierender Cholangitis). Die extrahepatische Cholestase ist rein durch eine mechanische Obstruktion verursacht. Gemischte Formen mit Beteiligung der intra- und der extrahepatischen Gallenwegen findet man bei der sklerosierenden Cholangitis.

Aus pathophysiologischer Sicht ist die Cholestase durch eine Reduktion oder völliges Sistieren des Galleflusses charakterisiert.

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Nur mit Berechtigung zugänglich

EASL Clinical Practice Guidelines. Management of cholestatic liver diseases. J Hepatol. 2009;51:237–67.CrossRef

Heathcote EJ. Diagnosis and management of cholestatic liver disease. Clin Gastroenterol Hepatol. 2007;5:776–82.PubMedCrossRef

Metcalf JV, Bhopal RS, Gray J, Howel D, James OF. Incidence and prevalence of primary biliary cirrhosis in the city of Newcastle upon Tyne, England. Int J Epidemiol. 1997;26:830–36.PubMedCrossRef

Kaplan MM, Gershwin ME. Primary biliary cirrhosis. N Engl J Med. 2005;353:1261–73.PubMedCrossRef

Invernizzi P, Lleo A, Podda M. Interpreting serological tests in diagnosing autoimmune liver diseases. Semin Liver Dis. 2007;27:161–72.PubMedCrossRef

Ludwig J, Dickson ER, McDonald GS. Staging of chronic nonsuppurative destructive cholangitis (syndrome of primary biliary cirrhosis). Virchows Arch A Pathol Anat Histol. 1978;379:103–12.PubMedCrossRef

Corpechot C, Carrat F, Poujol-Robert A, Gaouar F, Wendum D, Chazouilleres O, Poupon R. Noninvasive elastography-based assessment of liver fibrosis progression and prognosis in primary biliary cirrhosis. Hepatology. 2012;56:198–208.PubMedCrossRef

Heathcote EJ. Management of primary biliary cirrhosis. The American Association for the Study of Liver Diseases practice guidelines. Hepatology. 2000;31:1005–13.PubMedCrossRef

Harada K, Hirohara J, Ueno Y, Nakano T, Kakuda Y, Tsubouchi H, Ichida T, et al. Incidence of and risk factors for hepatocellular carcinoma in primary biliary cirrhosis: national data from Japan. Hepatology. 2013;57:1942–9.

10.

Bressler B, Pinto R, El-Ashry D, Heathcote EJ. Which patients with primary biliary cirrhosis or primary sclerosing cholangitis should undergo endoscopic screening for oesophageal varices detection? Gut. 2005;54:407–10.PubMedCentralPubMedCrossRef

11.

Paumgartner G, Beuers U. Mechanisms of action and therapeutic efficacy of ursodeoxycholic acid in cholestatic liver disease. Clin Liver Dis. 2004;8:67–81.PubMedCrossRef

12.

Rudic JS, Poropat G, Krstic MN, Bjelakovic G, Gluud C. Ursodeoxycholic acid for primary biliary cirrhosis. Cochrane Database Syst Rev 2012;12:CD000551.PubMed

13.

Pares A, Caballeria L, Rodes J. Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic acid. Gastroenterology. 2006;130:715–20.PubMedCrossRef

14.

Corpechot C, Abenavoli L, Rabahi N, Chretien Y, Andreani T, Johanet C, Chazouilleres O, et al. Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis. Hepatology. 2008;48:871–7.PubMedCrossRef

15.

Leuschner M, Maier KP, Schlichting J, Strahl S, Herrmann G, Dahm HH, Ackermann H, et al. Oral budesonide and ursodeoxycholic acid for treatment of primary biliary cirrhosis: results of a prospective double-blind trial. Gastroenterology. 1999;117:918–5.PubMedCrossRef

16.

Rautiainen H, Karkkainen P, Karvonen AL, Nurmi H, Pikkarainen P, Nuutinen H, Farkkila M. Budesonide combined with UDCA to improve liver histology in primary biliary cirrhosis: a three-year randomized trial. Hepatology. 2005;41:747–52.PubMedCrossRef

17.

Hempfling W, Grunhage F, Dilger K, Reichel C, Beuers U, Sauerbruch T. Pharmacokinetics and pharmacodynamic action of budesonide in early- and late-stage primary biliary cirrhosis. Hepatology. 2003;38:196–202.PubMedCrossRef

18.

Honda A, Ikegami T, Nakamuta M, Miyazaki T, Iwamoto J, Hirayama T, Saito Y, et al. Anticholestatic effects of bezafibrate in patients with primary biliary cirrhosis treated with ursodeoxycholic acid. Hepatology. 2013;57:1931–41.PubMedCrossRef

19.

Levy C, Peter JA, Nelson DR, Keach J, Petz J, Cabrera R, Clark V, et al. Pilot study: fenofibrate for patients with primary biliary cirrhosis and an incomplete response to ursodeoxycholic acid. Aliment Pharmacol Ther. 2011;33:235–42.PubMedCrossRef

20.

Mason A, Luketic V, Lindor K, Hirschfield G, Gordon S, Mayo M, Kowdley K, et al. Farnesoid-x receptor agonists: a new class of drugs for the treatment of PBC? An international study evaluating the addition of INT-747 to ursodeoxycholic acid. J Hepatol. 2010;52:S1–2.CrossRef

21.

Lee YM, Kaplan MM, LaRusso NF, Shneider BL, Black D, Gores GJ, James SP, et al. Primary sclerosing cholangitis. N Engl J Med. 1995;332:924–33.PubMedCrossRef

22.

Bjornsson E, Olsson R, Bergquist A, Lindgren S, Braden B, Chapman RW, Boberg KM, et al. The natural history of small-duct primary sclerosing cholangitis. Gastroenterology. 2008;134:975–80.PubMedCrossRef

23.

LaRusso NF, Shneider BL, Black D, Gores GJ, James SP, Doo E, Hoofnagle JH. Primary sclerosing cholangitis: summary of a workshop. Hepatology. 2006;44:746–64.PubMedCrossRef

24.

Kaya M, Petersen BT, Angulo P, Baron TH, Andrews JC, Gostout CJ, Lindor KD. Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis. Am J Gastroenterol. 2001;96:1059–66.PubMedCrossRef

25.

Alkhatib AA, Hilden K, Adler DG. Comorbidities, sphincterotomy, and balloon dilation predict post-ERCP adverse events in PSC patients: operator experience is protective. Dig Dis Sci. 2011;56:3685–8.PubMedCrossRef

26.

Eaton JE, Talwalkar JA, Lazaridis KN, Gores GJ, Lindor KD. Pathogenesis of primary sclerosing cholangitis and advances in diagnosis and management. Gastroenterology. 2013;145:521–36.

27.

Berstad AE, Aabakken L, Smith HJ, Aasen S, Boberg KM, Schrumpf E. Diagnostic accuracy of magnetic resonance and endoscopic retrograde cholangiography in primary sclerosing cholangitis. Clin Gastroenterol Hepatol. 2006;4:514–20.PubMedCrossRef

28.

Broome U, Olsson R, Loof L, Bodemar G, Hultcrantz R, Danielsson A, Prytz H, et al. Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis. Gut. 1996;38:610–5.PubMedCentralPubMedCrossRef

29.

Chapman RW, Arborgh BA, Rhodes JM, Summerfield JA, Dick R, Scheuer PJ, Sherlock S, et al. Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology. Gut. 1980;21:870–7.PubMedCentralPubMedCrossRef

30.

Lazaridis KN, Gores GJ. Primary sclerosing cholangitis and cholangiocarcinoma. Semin Liver Dis. 2006;26:42–51.PubMedCrossRef

31.

Lindor KD, Kowdley KV, Luketic VA, Harrison ME, McCashland T, Befeler AS, Harnois D, et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis. Hepatology. 2009;50:808–14.PubMedCentralPubMedCrossRef

32.

Abdalian R, Heathcote EJ. Sclerosing cholangitis: a focus on secondary causes. Hepatology. 2006;44:1063–74.PubMedCrossRef

33.

Maillette de Buy Wenniger L, Rauws EA, Beuers U. What an endoscopist should know about immunoglobulin-G4-associated disease of the pancreas and biliary tree. Endoscopy. 2012;44:66–73.PubMedCrossRef

34.

Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Clain JE, et al. Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer. Am J Gastroenterol. 2007;102:1646–53.PubMedCrossRef

35.

Ghazale A, Chari ST, Zhang L, Smyrk TC, Takahashi N, Levy MJ, Topazian MD, et al. Immunoglobulin G4-associated cholangitis: clinical profile and response to therapy. Gastroenterology. 2008;134:706–15.PubMedCrossRef

36.

Andrade RJ, Lucena MI, Fernandez MC, Pelaez G, Pachkoria K, Garcia-Ruiz E, Garcia-Munoz B, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology. 2005;129:512–21.PubMedCrossRef

37.

Zimmermann HJ. Drug-induced liver disease. In: Schiff ER, Sorrell MF, Maddrey WC, Herausgeber. Schiff’s diseases of the liver. 8. Aufl. Philadelphia: Lippincott; 1999. S. 973–1064.

38.

Lammert F, Marschall HU, Glantz A, Matern S. Intrahepatic cholestasis of pregnancy: molecular pathogenesis, diagnosis and management. J Hepatol. 2000;33:1012–21.PubMedCrossRef

39.

Bacq Y, Myara A, Brechot MC, Hamon C, Studer E, Trivin F, Metman EH. Serum conjugated bile acid profile during intrahepatic cholestasis of pregnancy. J Hepatol. 1995;22:66–70.PubMedCrossRef

40.

Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology. 2004;40:467–74.PubMedCrossRef

41.

Chand N, Sanyal AJ. Sepsis-induced cholestasis. Hepatology. 2007;45:230–41.PubMedCrossRef

42.

Trauner M, Fickert P, Stauber RE. Sepsis und Leber. Intensivmed Notfallmedizin. 2003;40:475–83.CrossRef

43.

Geier A, Fickert P, Trauner M. Mechanisms of disease: mechanisms and clinical implications of cholestasis in sepsis. Nat Clin Pract Gastroenterol Hepatol. 2006;3:574–85.PubMedCrossRef

44.

Engler S, Elsing C, Flechtenmacher C, Theilmann L, Stremmel W, Stiehl A. Progressive sclerosing cholangitis after septic shock: a new variant of vanishing bile duct disorders. Gut. 2003;52:688–93.PubMedCentralPubMedCrossRef

45.

Voigtlander T, Negm AA, Schneider AS, Strassburg CP, Manns MP, Wedemeyer J, Lankisch TO. Secondary sclerosing cholangitis in critically ill patients: model of end-stage liver disease score and renal function predict outcome. Endoscopy. 2012;44:1055–8.PubMedCrossRef

46.

Ruemmele P, Hofstaedter F, Gelbmann CM. Secondary sclerosing cholangitis. Nat Rev Gastroenterol Hepatol. 2009;6:287–95.PubMedCrossRef

47.

Alderlieste YA, van den Elzen BD, Rauws EA, Beuers U. Immunoglobulin G4-associated cholangitis: one variant of immunoglobulin G4-related systemic disease. Digestion. 2009;79:220–8.PubMedCrossRef

Titel: Cholestase – Update 2014
verfasst von: Gernot Zollner
Michael Trauner
Publikationsdatum: 01.08.2014
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift Education / Ausgabe 3-4/2014
Print ISSN: 1863-3579
Elektronische ISSN: 1863-3765
DOI: https://doi.org/10.1007/s11812-014-0061-2

Springer Medizin Österreich

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