Resumo

D'AMATO G, Mónica; RUIZ N, Patricia; AGUIRRE R, Karen  e  GOMEZ ROJAS, Susana. Cholestasis in Pediatrics. Rev Col Gastroenterol [online]. 2016, vol.31, n.4, pp.409-417. ISSN 0120-9957.

Cholestasis always indicates a pathological process that can result in chronic liver dysfunction, the necessity of liver transplantation and even death. (1) Cholestasis is a process in which there is a decrease in biliary flow, histological evidence of deposition of bile pigments in hepatocytes and bile ducts, and an increase in the serum concentrations of products excreted in bile. Cholestasis can occur at any age. It is caused by alteration of the formation of bile by the hepatocytes or by obstruction of the flow in the intrahepatic or extrahepatic biliary tracts. Neonatal cholestasis occurs in the first (3) months of life with elevated serum levels of direct bilirubin, cholesterol and bile acids. (2) In our environment, the most frequent cause is idiopathic neonatal hepatitis, followed by infectious causes. Obstructive causes have the worst prognoses. Among them, the most common is biliary atresia in which progressive obliteration of the extra hepatic biliary tract, parenchymal damage and intrahepatic biliary tract cause cirrhosis and death before the patient reaches three years of age. (1-3) The prognosis improves with surgical management if it is performed within the first 45 to 60 days of life. (3) The most common presentation is a healthy full-term newborn who develops jaundice, hypocolony, firm hepatomegaly and splenomegaly between the 2nd and 6th weeks of life. The principal serum marker that supports diagnosis is elevation of gamma glutamyltransferase while ultrasound of the liver following fasting has the greatest sensitivity and specificity. The only method for confirming the diagnosis is exploratory laparotomy with direct vision of the bile duct by intraoperative cholangiography. (4) In addition to correcting the cause and treating cholestasis, nutritional management with an adequate diet with high levels of medium chain triglycerides and fat-soluble vitamins is important for management of all patients with cholestasis. (5)

Palavras-chave : Cholestasis; jaundice; biliary atresia; hepatitis.

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