Blocked or slowed bile flow

Clinically: Cholestasis · also bile duct obstruction, blocked bile duct, biliary obstruction

hepatic MONDO MONDO:0001751 unverified

This describes what this condition typically looks like. It is not a diagnosis and cannot tell you whether you have it -- patterns overlap, results vary between labs, and the same numbers mean different things in different people. Diagnosis usually rests on Alkaline phosphatase, Gamma-glutamyl transferase, interpreted alongside symptoms and history rather than read off a report.

unverified These explanations are written to be easy to read and have not yet been checked against a source. The ranges and measurement notes on this page show theirs.

definition unverified

Bile is not draining out of your liver the way it should. Either something is blocking the pipes, or the liver is not pushing it along.

Impaired bile synthesis, secretion or excretion, so that bile flow from the liver is slowed or blocked; it is classed as intrahepatic (within the liver) or extrahepatic (outside it, e.g. bile-duct stones, strictures or tumours) and is characterised biochemically by elevated bilirubin and alkaline phosphatase.

caveats unverified

The pattern of which liver tests rise is what distinguishes this from liver cell injury. Here the drainage markers rise most; in hepatitis the cell damage markers do.

No clinical version written yet.

The typical lab pattern

What the diagnosis rests on

The results a diagnosis is actually made on.

Alkaline phosphatase	high	—	A raised ALP, mostly together with a raised GGT, is the lab sign of cholestasis. One national guideline (Chinese Society of Hepatology, 2021) sets the cut-off at ALP above 1.5 times the upper limit of normal plus GGT above 3 times.
Gamma-glutamyl transferase	high	—	GGT is part of the same cut-off (above 3 times the upper limit of normal), and a raised GGT confirms that a raised ALP comes from the liver rather than bone. Some rare inherited forms of cholestasis have a normal GGT.

Consistent with it

Fits the picture, but not enough on its own.

Bilirubin, total	high	—	Bilirubin can be raised in cholestasis, mainly at more advanced stages, but it is also raised in liver-cell injury, so it does not tell the two apart.
Alanine aminotransferase	high	—	ALT can also rise in cholestasis, but less than ALP. In drug-induced cholestatic injury, the ALT-to-ALP ratio is below 2.

How it usually feels

Frequencies say how often a symptom accompanies this condition — not the other way round. Most people with any of these symptoms do not have this.