What is cholestasis?

Reviewed by Pathologists on:
January 6, 2026

Cholestasis is a condition in which the flow of bile is reduced or blocked. Bile is a fluid made by the liver that helps digest fats and remove waste products from the body. When bile cannot flow normally, it accumulates in the liver and bloodstream, leading to symptoms and damage to liver cells over time.

Cholestasis is not a disease in itself. Instead, it is a finding that can occur in many different medical conditions affecting the liver, bile ducts, or gallbladder.

What does bile do?

Bile plays several vital roles in the body. It helps break down fats in the intestine so they can be absorbed. It also carries waste products, including bilirubin and excess cholesterol, out of the liver.

Bile normally flows from the liver through small channels called bile ducts, then into larger bile ducts, and finally into the intestine. Cholestasis occurs when this flow is slowed or stopped.

Where does cholestasis occur?

Cholestasis can occur at different points along the bile pathway. Intrahepatic cholestasis occurs when bile flow is impaired within the liver itself. Extrahepatic cholestasis occurs when bile flow is blocked outside the liver, usually in the larger bile ducts. The location of cholestasis helps doctors determine the underlying cause.

What causes cholestasis?

A wide range of conditions can cause cholestasis. Common causes include problems within the liver and blockages outside the liver.

Causes within the liver may include inflammation of the liver, medication side effects, infections, autoimmune diseases, genetic conditions, and certain hormone-related states, such as pregnancy.

Causes outside the liver often involve physical blockage of the bile ducts, such as gallstones, scarring, inflammation, or tumours pressing on or growing within the bile ducts. In some cases, more than one factor may contribute to cholestasis.

What are the symptoms of cholestasis?

Symptoms depend on how severe the bile blockage is and how long it has been present. Some people may have no symptoms, especially early on.

When symptoms occur, they may include yellowing of the skin and eyes (jaundice), dark urine, pale stools, itching, fatigue, and abdominal discomfort. Long-standing cholestasis can interfere with fat absorption and the absorption of fat-soluble vitamins.

What does cholestasis look like under the microscope?

When liver tissue is examined under the microscope, cholestasis is characterized by bile accumulation in areas where it should not normally be present. Pathologists recognize two main patterns that help describe where bile is building up.

Hepatocellular cholestasis

Hepatocellular cholestasis means that bile is accumulating inside liver cells, which are called hepatocytes. Hepatocytes are the primary working cells of the liver and are responsible for making bile.

When bile cannot be transported adequately out of these cells, it builds up inside them and appears as yellow-green material under the microscope. This pattern suggests that the liver cells themselves are having trouble moving bile forward.

Canalicular cholestasis

Canalicular cholestasis means that bile is accumulating in the tiny channels between liver cells, called bile canaliculi. These channels normally carry bile away from liver cells toward the bile ducts.

Under the microscope, canalicular cholestasis appears as bile plugs within these small channels. This pattern suggests that bile is being produced but cannot flow normally through the bile drainage system.

Additional findings

Depending on the cause and duration of cholestasis, pathologists may also see liver cell injury, inflammation, or changes in bile ducts. These additional features help determine whether cholestasis is recent, long-standing, or related to a specific disease.

Why might cholestasis be mentioned in a pathology report?

Cholestasis may be described in a pathology report when a liver biopsy or surgical specimen shows evidence of impaired bile flow. This finding helps doctors understand why a person may have abnormal liver blood tests or symptoms such as jaundice or itching.

The pathology report often includes additional findings that help identify the cause of cholestasis and guide further testing or treatment.

Is cholestasis serious?

Cholestasis can be mild and temporary or more severe and long-lasting, depending on the cause. In many cases, treating the underlying condition allows bile flow to return to normal.

If cholestasis is severe or long-standing, it can lead to liver damage, scarring, or nutritional deficiencies. For this reason, identifying and addressing the cause is important.

Questions to ask your doctor

• What is causing cholestasis in my case?

• Is the problem located in the liver or the bile ducts?

• Do I need additional tests or imaging studies?

• Can this condition be treated or reversed?

• Will my liver function need to be monitored over time?