[Differential diagnosis in cholestatic liver diseases]

Causes of cholestasis include disturbed bile flow out of the hepatocyte into the biliary capillaries, or obstruction (stone, tumor, inflammation) of small or larger intrahepatic or extrahepatic. In the event of acute or subacute onset, Cholestatic liver disease becomes manifest by its clinical presentation; in the case of a chronic course it tends to be an incidental finding based on liver parameters. For the differential diagnosis, the history (duration of symptoms, general symptoms, family history, drug history), clinical picture, laboratory investigations (alkaline phosphatase, g-GT, possibly specific autoantibodies) and imaging procedures (in particular ultrasonography and ERCP) point in the right direction. The present article provides an overview of the major differential diagnoses of intrahepatic and extrahepatic cholestasis. A diagnostic algorithm is presented.