Differenzialdiagnostik der Cholestase bei Erwachsenen

Cholestase bezeichnet eine Störung der Gallebildung bzw. des Galleflusses aus der Leber in den Darm. Man unterscheidet 2 Hauptformen, einerseits Krankheitsbilder, die zu einer Akkumulation gallepflichtiger Substanzen in den Hepatozyten führen und häufig als primäre Cholestase bezeichnet werden, von andererseits solchen Erkrankungen, bei denen eine Schädigung der Gallenwege im Vordergrund steht und die unter dem Begriff Cholangiopathien subsumiert werden.

Kernaussagen

• Bei primärer Cholestase finden sich erhöhte AST, ALT und Serumgallensäuren.

• Bei Cholangiopathie sind ALP, GGT und ggf. Bilirubin erhöht.

• Medikamente, weibliche Geschlechtshormone und Infektionen sind häufige Auslöser einer primären Cholestase.

• ABCB11-Mutationen können für eine primäre Cholestase prädisponieren.

• PBC, PSC, AIC sind häufige Ursachen einer Cholangiopathie.

• ABCB4-Mutationen prädisponieren zu ICP, LPAC und Cholangiopathie.

Schlüsselwörter

primäre Cholestase - Cholangiopathie - BSEP - GGT - ABCB4

Publication History

Article published online:
11 December 2025

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