Interdisciplinary Approaches to Cholestatic Jaundice: Diagnostic, Pharmacologic, and Nursing Perspectives
Abstract
Background: Cholestatic jaundice is a syndrome resulting from impaired bile formation or flow, leading to the systemic accumulation of biliary constituents like bilirubin and bile acids. It is clinically categorized into intrahepatic causes, affecting hepatocytes or small ducts, and extrahepatic causes, involving mechanical obstruction of the large bile ducts.
Aim: This article aims to provide a comprehensive, interdisciplinary overview of the diagnostic, pharmacologic, and nursing management of cholestatic jaundice, emphasizing the integration of clinical evaluation, targeted testing, and collaborative care to optimize patient outcomes.
Methods: The approach involves a systematic diagnostic workup beginning with clinical history, physical examination, and liver biochemistry. Key methods include imaging, notably ultrasound to detect ductal dilation, followed by MRCP or ERCP for definitive diagnosis and intervention in obstructive cases. For intrahepatic causes, serologic testing and liver biopsy are employed to identify etiologies such as drug-induced injury, autoimmune cholangiopathies, or genetic disorders.
Results: Management is etiology-driven. Extrahepatic obstruction requires timely biliary decompression via endoscopic, percutaneous, or surgical methods. Intrahepatic cholestasis management focuses on treating the underlying disease, managing pruritus with a stepped pharmacologic approach (e.g., bile acid sequestrants, rifampin, naltrexone), and correcting nutritional deficiencies, particularly of fat-soluble vitamins.
Conclusion: Effective management of cholestatic jaundice hinges on accurate anatomical localization of the defect and a multidisciplinary, patient-centered approach. Collaboration between gastroenterologists, radiologists, surgeons, nurses, and pharmacists is essential for timely diagnosis, intervention, and supportive care, ultimately improving symptom control and preventing long-term complications.
Full text article
References
Hasan MS, Karim AB, Rukunuzzaman M, Haque A, Akhter MA, Shoma UK, Yasmin F, Rahman MA. Role of Liver Biopsy in the Diagnosis of Neonatal Cholestasis due to Biliary Atresia. Mymensingh Med J. 2018 Oct;27(4):826-833.
Nunes TF, Tibana TK, Santos RFT, de Faria BB, Marchiori E. Percutaneous transhepatic cholangiobiopsy. Radiol Bras. 2019 Jan-Feb;52(1):41-42.
Chen HL, Wu SH, Hsu SH, Liou BY, Chen HL, Chang MH. Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases. J Biomed Sci. 2018 Oct 26;25(1):75.
Fargo MV, Grogan SP, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician. 2017 Feb 01;95(3):164-168.
Hilscher MB, Kamath PS, Eaton JE. Cholestatic Liver Diseases: A Primer for Generalists and Subspecialists. Mayo Clin Proc. 2020 Oct;95(10):2263-2279.
Feldman AG, Sokol RJ. Neonatal Cholestasis: Updates on Diagnostics, Therapeutics, and Prevention. Neoreviews. 2021 Dec 01;22(12):e819-e836.
Liu X, Xu B, Zeng Y, Chen P, Wang Y. Case report: Severe cholestatic jaundice associated with hyperthyroidism treated with methimazole. Medicine (Baltimore). 2023 Nov 10;102(45):e35972.
Robie DK, Overfelt SR, Xie L. Differentiating biliary atresia from other causes of cholestatic jaundice. Am Surg. 2014 Sep;80(9):827-31.
Siddiqui AI, Ahmad T. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Biliary Atresia.
Fricker ZP, Lichtenstein DR. Primary Sclerosing Cholangitis: A Concise Review of Diagnosis and Management. Dig Dis Sci. 2019 Mar;64(3):632-642.
Zhu Y, Wang S, Zhao S, Qi L, Li Z, Bai Y. Obstructive jaundice due to a blood clot after ERCP: a case report and review of the literature. BMC Gastroenterol. 2018 Nov 03;18(1):163.
Gunaydin M, Bozkurter Cil AT. Progressive familial intrahepatic cholestasis: diagnosis, management, and treatment. Hepat Med. 2018;10:95-104.
Dasari BVM, Ionescu MI, Pawlik TM, Hodson J, Sutcliffe RP, Roberts KJ, Muiesan P, Isaac J, Marudanayagam R, Mirza DF. Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta-analysis. J Surg Oncol. 2018 Sep;118(3):477-485.
Madhani K, Farrell JJ. Management of Autoimmune Pancreatitis. Gastrointest Endosc Clin N Am. 2018 Oct;28(4):493-519.
Vandenabeele LAM, Dhondt E, Geboes KP, Defreyne L. Percutaneous stenting in malignant biliary obstruction caused by metastatic disease: clinical outcome and prediction of survival according to tumor type and further therapeutic options. Acta Gastroenterol Belg. 2017 Apr-Jun;80(2):249-255.
Smith SE. Management of Acute Cholangitis and Choledocholithiasis. Surg Clin North Am. 2024 Dec;104(6):1175-1189.
An Z, Braseth AL, Sahar N. Acute Cholangitis: Causes, Diagnosis, and Management. Gastroenterol Clin North Am. 2021 Jun;50(2):403-414.
Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol. 2023 Jan;20(1):26-36.
Authors
Copyright (c) 2025 Musab Mohammed Faqihi, Hana Mohammed S Al-Anazi, Abdulaziz Masad Alharbi, Ahmed Mohammed Ahmed Othman, Aseel Jamil Ahmed Othman, Khaloud Abdullah Alnassar, Amnah Muharib Alanazi, Waleed Hassan Zaylaee, Khalid Fahd Ali Alrushaidan, Hamdah Mutair Awadh Alenazi, Sultan Omar Ahmed Hakami, Ibrahim Essa Jaafari, Amal Ali Makki Hanshli
This work is licensed under a Creative Commons Attribution 4.0 International License.