Which symptom is an early feature of biliary dysfunction due to cholestasis?

• A. Itchy skin
• B. Abdominal mass
• C. Bloody stool
• D. Cough

Answer: (A)

Pruritus from bile acid retention is an early feature of biliary dysfunction due to cholestasis. When bile flow is impaired, bile acids accumulate in the bloodstream and deposit in the skin, triggering itch that can appear before obvious jaundice. This mechanism explains why itchy skin is the best early clue. The other options don’t fit as early signs of cholestasis: an abdominal mass isn’t a typical early manifestation of bile flow obstruction, a bloody stool points to GI bleeding, and a cough is unrelated to biliary disease. As cholestasis progresses, you may see dark urine and pale stools, alongside jaundice.