management
Last reviewed 01/2018
General management:
- nutrition - problem is that of intestinal bile salt deficiency:
- calorie and protein intake must be maintained but fat reduced. Additional fat supplied by medium chain triglycerides e.g. Portagen or coconut oil
- fat soluble vitamins - A, D, E, K - may need to be supplemented if signs of deficiency
- pruritus - options:
- external biliary drainage
- cholestyramine
- phototherapy
- ursodeoxycholic acid
- rifampicin
- hepatic osteodystrophy may require vitamin D, phosphate or calcium; oestrogens in postmenopausal women
Extrahepatic cholestasis often requires surgical management.
Note that the use of clofibrate therapy in the hyperlipidaemia associated of cholestasis is associated with a raised serum cholesterol.