Bile Retention and
Its Clinical Manifestations (MCM part 4)
When bile retention is present, patients
will show following symptoms:
Jaundice is the first symptom of
bile retention. When serum bilirubin increases and secretion of urine
bilirubin imbalance, jaundice start to show up. The degree of jaundice
can be described from golden yellow, yellowish green, dark brown to deep
dark green. This degree of change is related to the advancement of
the disease. When the urine turns to be dark brown and at the same time,
stool becomes pale and sometimes clay color.
- Itchy skin, usually starts on the sole
and palm and gradually spreads to the whole body. The itch can be very
severe and persistent, which can also affect sleep. The severity of
the itch is related to the elevation of the level of bile acid in the
serum. With the liver function improving after treatment, the itching
can also be reduced or eliminated completely.
- Fat absorption deterioration: because
much less bile acid secrets into the intestine, fat digestion is
affected. Bile acid is the major chemical in the digestion and absorption
of fat. Therefore, the fat in food will not be absorbed, which can
cause fatty diarrhea. At the same time, the body will not absorb
vitamins such as vitamin A, K, D, E, which are only dissolved in fat,.
The deficiency of these vitamins can cause night-blindness, dry cornea
and skin, bleeding and osteoporosis.
- High cholesterol, which can cause
cardiovascular problems. On the face, these will be xanthomas around
Although the above listed
symptoms could happen in bile retention, the most common and often seen
symptoms are jaundice, skin itch and urine and stool color changes. Only
in long-term chronic bile retention, with progressive deepening jaundice
that fatty diarrhea, osteoporosis, and xanthoma could happen.
Some blood tests can also indicate bile
retention. They are:
Serum's total and direct
- Serum cholesterol level increase.
- GGT, ALP, increase, especially the
levels of these enzymes three times higher than normal.
Bile retention is not an
independent disease, but it is an important symptom and needs to be
treated, otherwise it can promote fibrosis of the liver.