Jaundice Dr. Ahmed Kensarah. Introduction Surgical obstructive jaundice (jaundice due to intra- or...

JaundiceJaundice

Dr. Ahmed KensarahDr. Ahmed Kensarah

IntroductionIntroduction

Surgical obstructive jaundice (jaundice due to intra- or Surgical obstructive jaundice (jaundice due to intra- or extra-hepatic organic obstruction to biliary outflow) can extra-hepatic organic obstruction to biliary outflow) can present problems in diagnosis and management. This present problems in diagnosis and management. This is so because, there is a hard core of jaundiced is so because, there is a hard core of jaundiced patients in whom it is very difficult to distinguish patients in whom it is very difficult to distinguish between organic obstruction and medical causes of between organic obstruction and medical causes of jaundice, particularly intrahepatic cholestasis. Even jaundice, particularly intrahepatic cholestasis. Even serial liver function tests are often inconclusive in serial liver function tests are often inconclusive in differentiating However, it is mandatory to determine differentiating However, it is mandatory to determine pre-operatively the existence, the nature and the site pre-operatively the existence, the nature and the site of obstruction in the surgical cases because an ill of obstruction in the surgical cases because an ill chosen therapeutic approach can be dangerous.chosen therapeutic approach can be dangerous.

Material and MethodsMaterial and Methods

Twenty-six consecutive cases of obstructive jaundice Twenty-six consecutive cases of obstructive jaundice were diagnosed and treated in one full-time surgical were diagnosed and treated in one full-time surgical unit over a period of 3 years from 1976 to 1979. Of unit over a period of 3 years from 1976 to 1979. Of these, 14 cases had malignancy and 12 cases these, 14 cases had malignancy and 12 cases belonged to the non-malignant group. A11 the patients belonged to the non-malignant group. A11 the patients were above 40 years of age and the male: female ratio were above 40 years of age and the male: female ratio was 1.9:1.was 1.9:1.The patients were subjected to a detailed clinical The patients were subjected to a detailed clinical examination particularly with reference to the examination particularly with reference to the enlargement of liver, spleen and gall bladder. They enlargement of liver, spleen and gall bladder. They also had urine examination, hemogram and, serum also had urine examination, hemogram and, serum chemistry including liver function tests. chemistry including liver function tests.

Material and Methods (cont.)Material and Methods (cont.)

Australia antigen examination was done in 15 Australia antigen examination was done in 15 cases. Citrate clearance test' was done in 12 cases. Citrate clearance test' was done in 12 patients. All the patients had plain X-ray of patients. All the patients had plain X-ray of abdomen and upper GI Barium series. Oral abdomen and upper GI Barium series. Oral cholecystography was done in 7 patients cholecystography was done in 7 patients whose serum bilirubin was less than 3 mg%,-. whose serum bilirubin was less than 3 mg%,-. Percutaneous transhepatic cholangiography Percutaneous transhepatic cholangiography (PTC) was done in 9 patients. Liver scan using (PTC) was done in 9 patients. Liver scan using 99mTc phytate was done in 13 cases. 99mTc phytate was done in 13 cases. Selective hepatic angiography was done pre-Selective hepatic angiography was done pre-operatively in 2 patients.operatively in 2 patients.


The patients were prepared for surgery with The patients were prepared for surgery with injectable Vitamin K to correct the injectable Vitamin K to correct the prothrombin time; they were given fresh prothrombin time; they were given fresh blood transfusions if the prothrombin time blood transfusions if the prothrombin time did not improve. In order to avert possible did not improve. In order to avert possible post-operative renal failure, all patients post-operative renal failure, all patients were treated with correction of were treated with correction of dehydration, intravenous Mannitol and dehydration, intravenous Mannitol and intravenous Frusemide pre-operatively.intravenous Frusemide pre-operatively.


PTCD-Percutaneous Transhepatic Cholangiography with PTCD-Percutaneous Transhepatic Cholangiography with drainage.drainage.

The patients were treated with various surgical The patients were treated with various surgical procedures as shown in [Table 1]. Some of the patients procedures as shown in [Table 1]. Some of the patients had more than one surgical procedures mentioned in had more than one surgical procedures mentioned in the table. Curative surgery was attempted in benign the table. Curative surgery was attempted in benign conditions and in early malignancies. In the advanced conditions and in early malignancies. In the advanced malignancies; surgery was mainly palliative.malignancies; surgery was mainly palliative.Whenever bile could be obtained either during P.T.C. Whenever bile could be obtained either during P.T.C. or during laparotomy (20 cases), it was subjected to or during laparotomy (20 cases), it was subjected to bacteriological examination.bacteriological examination.


Intra-operative cholangiography was done in Intra-operative cholangiography was done in 3 cases and it showed the sites of 3 cases and it showed the sites of obstruction. Tube cholangiography was obstruction. Tube cholangiography was done post-operatively in 11 cases either done post-operatively in 11 cases either through the cholecystostomy tube or through the cholecystostomy tube or through a splint kept in the biliary tree.through a splint kept in the biliary tree.

Results (cont.)Results (cont.)

The patient with hepatoma of the liver and one patient The patient with hepatoma of the liver and one patient with carcinoma of the gall bladder infiltrating into the with carcinoma of the gall bladder infiltrating into the liver had hard enlarged liver. There were 6 cases liver had hard enlarged liver. There were 6 cases who illustrated an exception to Courvoisiers law.Of who illustrated an exception to Courvoisiers law.Of these, 4 were patients with cholelithiasis and a these, 4 were patients with cholelithiasis and a palpable gall bladder; of these, 2 had an associated palpable gall bladder; of these, 2 had an associated malignancy of the biliary tract. The remaining 2 malignancy of the biliary tract. The remaining 2 exceptions were patients with malignant obstruction exceptions were patients with malignant obstruction of the lower end of the common bile duct (CBD), in of the lower end of the common bile duct (CBD), in whom the gall bladder was not palpable; in one of whom the gall bladder was not palpable; in one of them, this was due to an associated carcinoma of them, this was due to an associated carcinoma of the right hepatic duct involving the cystic duct.the right hepatic duct involving the cystic duct.


Nineteen out of the 26 patients had serum albumin level of Nineteen out of the 26 patients had serum albumin level of less than 3 gms per cent. The average total serum less than 3 gms per cent. The average total serum bilirubin was 10.4 mg%, the highest being 35.5 mg%; bilirubin was 10.4 mg%, the highest being 35.5 mg%; and the lowest being 1.6 mg%. The SGPT' was and the lowest being 1.6 mg%. The SGPT' was elevated (more than 40 Reitman and Frankel units/ml) elevated (more than 40 Reitman and Frankel units/ml) in 11 patients; it was more than 1G0 Reitman and in 11 patients; it was more than 1G0 Reitman and Frankel Units /ml in 10 patients. The alkaline Frankel Units /ml in 10 patients. The alkaline phosphatase was elevated (more than 30 K.A. units) in phosphatase was elevated (more than 30 K.A. units) in 19 patients; it was normal in 7 patients. The prothrombin 19 patients; it was normal in 7 patients. The prothrombin time was elevated (more than 16, seconds) in all time was elevated (more than 16, seconds) in all patients. Citrate clearance was abnormal in all the patients. Citrate clearance was abnormal in all the patients.patients.


Plain X-ray abdomen showed enlarged liver shadows in 8 Plain X-ray abdomen showed enlarged liver shadows in 8 patients and radio opaque gall stones in 5 patients. Barium patients and radio opaque gall stones in 5 patients. Barium meal examination of the G.I. tract showed chronic gastritis meal examination of the G.I. tract showed chronic gastritis with duodenal ulcer in 1 case of gall stones, indentation of with duodenal ulcer in 1 case of gall stones, indentation of duodenum by enlarged common bile duct in 3 patients, duodenum by enlarged common bile duct in 3 patients, `inverted three' (8) appearance in periampullary malignancy `inverted three' (8) appearance in periampullary malignancy (1 case), widening of duodenal C in 2 cases of carcinoma of (1 case), widening of duodenal C in 2 cases of carcinoma of head of pancreas and displacement of the stomach by head of pancreas and displacement of the stomach by enlarged liver in 1 case of hepatoma of the liver.enlarged liver in 1 case of hepatoma of the liver.Oral cholecystography showed filling defects suggestive of Oral cholecystography showed filling defects suggestive of stones in 2 patients and failure of visualisation of the gall stones in 2 patients and failure of visualisation of the gall bladder in 4 patients; it was normal in 1 patient whose serum bladder in 4 patients; it was normal in 1 patient whose serum bilirubin was 1.6 mg%.bilirubin was 1.6 mg%.


PTC showed obstruction at the lower end of the PTC showed obstruction at the lower end of the CBD in 5 cases, 2 due to stones, 2 due to CBD in 5 cases, 2 due to stones, 2 due to malignancy and one due to inflammatory malignancy and one due to inflammatory stricture. PTC also helped to diagnose stricture. PTC also helped to diagnose choledochal cyst in 2 cases (which showed choledochal cyst in 2 cases (which showed dilated CBD) and it showed dilated intrahepatic dilated CBD) and it showed dilated intrahepatic ducts filled with stones in 2 cases.ducts filled with stones in 2 cases.

Results (cont.)Results (cont.)Selective hepatic angiography showed an avascular area in Selective hepatic angiography showed an avascular area in

the patient with intrahepatic choledochal cyst and in the the patient with intrahepatic choledochal cyst and in the patient with hepatoma, it outlined the vascular tumor.patient with hepatoma, it outlined the vascular tumor.Hepatic scanning showed mild to moderate hepatomegaly Hepatic scanning showed mild to moderate hepatomegaly in 12 cases. Two patients showed cold areas in the liver in 12 cases. Two patients showed cold areas in the liver and another 2 in the region of the gall bladder invaginating and another 2 in the region of the gall bladder invaginating into the liver substance suggesting a gall bladder mass. into the liver substance suggesting a gall bladder mass. Sparse and scattered uptake by the liver suggestive of mild Sparse and scattered uptake by the liver suggestive of mild to moderate affection of liver function was seen in 9 cases.to moderate affection of liver function was seen in 9 cases.Bacteriological examination of bile showed Staphylococcus Bacteriological examination of bile showed Staphylococcus (coagulase positive) in 3 cases, E. coli in 4, Klebsiella in 3, (coagulase positive) in 3 cases, E. coli in 4, Klebsiella in 3, Proteus in 3, Pseudomonas in 1 and Salmonella typhi in 1. Proteus in 3, Pseudomonas in 1 and Salmonella typhi in 1. In 2 cases, more than one organism was present. The bile In 2 cases, more than one organism was present. The bile was sterile in 6 patients.was sterile in 6 patients.


The surgical procedures performed are outlined in The surgical procedures performed are outlined in [Table 1]. Percutaneous Transhepatic [Table 1]. Percutaneous Transhepatic Cholangiography with drainage (PTCD) using a Cholangiography with drainage (PTCD) using a polyethylene PTCD set (commercially available) polyethylene PTCD set (commercially available) was done in 3 patients. This served as a palliative was done in 3 patients. This served as a palliative procedure to drain the bile. However, the procedure to drain the bile. However, the maintainance of this tube was difficult.maintainance of this tube was difficult.Cholecystostomy was done in 5 patients. This was Cholecystostomy was done in 5 patients. This was done under local anaesthesia whenever the done under local anaesthesia whenever the patient's general condition and clotting was poor. patient's general condition and clotting was poor. In 2 patients it was done as the only (palliative) In 2 patients it was done as the only (palliative) procedure.procedure.


The commonest procedure performed (15 cases) The commonest procedure performed (15 cases) was a cholecystectomy, with exploration of the was a cholecystectomy, with exploration of the common bile duct together with removal of common bile duct together with removal of stones or dilatation of stricture. This was stones or dilatation of stricture. This was followed by sphincteroplasty and internal followed by sphincteroplasty and internal splintage with a sterile plastic tube. The splintage with a sterile plastic tube. The duodenum had to be opened in most cases. The duodenum had to be opened in most cases. The splintage tube would then be brought out splintage tube would then be brought out through a high choledochotomy or sometimes through a high choledochotomy or sometimes through the liver to come out externally from the through the liver to come out externally from the anterior abdominal wall. anterior abdominal wall.

Results (cont.)Results (cont.)The other end of the tube would lie in the duodenum across The other end of the tube would lie in the duodenum across

the obstruction and the sphincter, with a few side holes in the obstruction and the sphincter, with a few side holes in that part which lay in the CBD. The lengths of the tubes and that part which lay in the CBD. The lengths of the tubes and the sites of the holes were carefully measured as it was the sites of the holes were carefully measured as it was possible to change the tube if necessary in the possible to change the tube if necessary in the postoperative period when the tract was established. This postoperative period when the tract was established. This procedure was done in all cases of cholelithiasis with procedure was done in all cases of cholelithiasis with obstruction to CBD and also in many cases of malignant obstruction to CBD and also in many cases of malignant and inflammatory strictures of CBD.and inflammatory strictures of CBD.The histopathological confirmation of the cause of The histopathological confirmation of the cause of obstructive jaundice could be established in most cases on obstructive jaundice could be established in most cases on exploration. Eleven patients developed complications during exploration. Eleven patients developed complications during the post-operative period: biliary peritonitis in 2, wound the post-operative period: biliary peritonitis in 2, wound infection in 6, G.I. bleeding in 2 and right subphrenic infection in 6, G.I. bleeding in 2 and right subphrenic abscess in one.abscess in one.

DiscussionDiscussionObstructive lesions of the biliary system are difficult problems Obstructive lesions of the biliary system are difficult problems

for the surgeon. Majority of the patients are old and poor for the surgeon. Majority of the patients are old and poor surgical risks.surgical risks.Clinical symptoms are fairly typical although jaundice itself Clinical symptoms are fairly typical although jaundice itself makes the patient seek surgical aid. Charcot's triad of makes the patient seek surgical aid. Charcot's triad of intermittent fever, pain and jaundice is characteristic of intermittent fever, pain and jaundice is characteristic of ascending cholangitis and indicates biliary obstruction.ascending cholangitis and indicates biliary obstruction. Hepatomegaly is present in most cases of obstructive Hepatomegaly is present in most cases of obstructive jaundice and is due to congestion and stretching out of jaundice and is due to congestion and stretching out of intrahepatic biliary spaces. Long-standing biliary obstruction intrahepatic biliary spaces. Long-standing biliary obstruction can also cause portal hypertension. This was seen in 2 of can also cause portal hypertension. This was seen in 2 of our patients who had palpable spleen. A palpable gall our patients who had palpable spleen. A palpable gall bladder usually indicates obstruction of the distal CBD, due bladder usually indicates obstruction of the distal CBD, due to other causes than stone (Courvoisier's law). However, to other causes than stone (Courvoisier's law). However, exceptions to Courvoisier's law are common,as seen in 6 exceptions to Courvoisier's law are common,as seen in 6 patients in our series.patients in our series.

Discussion (cont.)Discussion (cont.)It is necessary to follow a standard system of investigations It is necessary to follow a standard system of investigations

in order to arrive at a correct diagnosis of obstructive in order to arrive at a correct diagnosis of obstructive jaundice and also to assess fitness for surgery. An jaundice and also to assess fitness for surgery. An increased WBC count and ESR indicates severity of increased WBC count and ESR indicates severity of biliary sepsis. Bile salts and pigments in urine and absent biliary sepsis. Bile salts and pigments in urine and absent urobilinogen also favour the diagnosis of obstructive urobilinogen also favour the diagnosis of obstructive jaundice. Serum albumin and prothrombin time are good jaundice. Serum albumin and prothrombin time are good indicators of liver function derangement. Serum bilirubin indicators of liver function derangement. Serum bilirubin levels indicate severity of jaundice and high direct levels indicate severity of jaundice and high direct bilirubin rules out hemolytic jaundice. Mild elevation of bilirubin rules out hemolytic jaundice. Mild elevation of SGPT levels are also seen in obstructive jaundice SGPT levels are also seen in obstructive jaundice consistent with liver dysfunction. An elevated alkaline consistent with liver dysfunction. An elevated alkaline phosphatase (above 30 K.A. units) is ,always present in phosphatase (above 30 K.A. units) is ,always present in obstructive jaundice.obstructive jaundice.

Discussion (cont.)Discussion (cont.)Plain X-ray of the abdomen may fail to show gall Plain X-ray of the abdomen may fail to show gall

stones (4 out of 9 were radiolucent in our series). stones (4 out of 9 were radiolucent in our series). Barium series of the upper G.I. tract are very Barium series of the upper G.I. tract are very informative especially in peri-ampullary carcinoma informative especially in peri-ampullary carcinoma (E appearance) and carcinoma of head of (E appearance) and carcinoma of head of pancreas (widening of duodenal C). Oral pancreas (widening of duodenal C). Oral cholecystography and intravenous cholecystography and intravenous cholangiography are of limited usefulness in cholangiography are of limited usefulness in obstructive jaundice.Hypotonic duodenography obstructive jaundice.Hypotonic duodenography and endoscopic retrograde and endoscopic retrograde cholangiopancreaticography (ERCP) can also be cholangiopancreaticography (ERCP) can also be of immense diagnostic value. These were not done of immense diagnostic value. These were not done in our series.in our series.

Discussion (cont.)Discussion (cont.)PTC is an extremely useful investigation in the diagnosis of PTC is an extremely useful investigation in the diagnosis of

the nature and site of block in obstructive jaundice. An the nature and site of block in obstructive jaundice. An acceptably low complication rate has been reported in acceptably low complication rate has been reported in several recent series and with the new Chiba needle several recent series and with the new Chiba needle technique, the procedure has been widely accepted in technique, the procedure has been widely accepted in the past few years. PTC is usually done just prior to the past few years. PTC is usually done just prior to exploration of the patient as several complications exploration of the patient as several complications following PTC have been described. In our series only following PTC have been described. In our series only one patient developed biliary peritonitis following PTC. one patient developed biliary peritonitis following PTC. Other complications were not seen. Per-operative Other complications were not seen. Per-operative cholangiograms (3 cases in our series) are reliable in 951 cholangiograms (3 cases in our series) are reliable in 951 of cases and may be used on the table if the site of of cases and may be used on the table if the site of obstruction is not clear, to confirm that all stones have obstruction is not clear, to confirm that all stones have been removed and pre-operative PTC was not done.been removed and pre-operative PTC was not done.

Discussion (cont.)Discussion (cont.)

Hepatic angiograms are useful in vascular Hepatic angiograms are useful in vascular tumors and space occupying lesions in the tumors and space occupying lesions in the liver.99mTc Phytate liver scan is a useful non-liver.99mTc Phytate liver scan is a useful non-invasive procedure which can outline cold invasive procedure which can outline cold areas in the liver and can give an idea of liver areas in the liver and can give an idea of liver function. Rose Bengal liver scan (not done in function. Rose Bengal liver scan (not done in our series) can indicate the site of obstruction.our series) can indicate the site of obstruction.


Ultrasound scanning of the abdomen (not done in our Ultrasound scanning of the abdomen (not done in our series) is another useful non-invasive investigation in series) is another useful non-invasive investigation in the diagnosis of obstructive jaundice. This method the diagnosis of obstructive jaundice. This method utilises physical and mechanical means of producing utilises physical and mechanical means of producing an image by reflected ultrasonic pulses created by an image by reflected ultrasonic pulses created by stimulation of a piezoelectric transducer. The images stimulation of a piezoelectric transducer. The images are recorded' as dots of varying brightness (B mode are recorded' as dots of varying brightness (B mode studies or Beta scanning). Gall bladder dilatation in studies or Beta scanning). Gall bladder dilatation in obstructive jaundice is easily demonstrable by B obstructive jaundice is easily demonstrable by B mode scanning and gall stones can also be mode scanning and gall stones can also be recognised by the presence of strong internal recognised by the presence of strong internal echoes within the normally echo-free bile.echoes within the normally echo-free bile.


Bacteriological examination of bile should be Bacteriological examination of bile should be done in every case as sepsis is common in an done in every case as sepsis is common in an obstructed biliary tree. Large number of obstructed biliary tree. Large number of pathogenic bacteria can be isolated from the pathogenic bacteria can be isolated from the bile in 50% of the cases requiring surgery on bile in 50% of the cases requiring surgery on the biliary tract. Patients with biliary sepsis may the biliary tract. Patients with biliary sepsis may develop clinical septicaemia before or after develop clinical septicaemia before or after operation. This was seen in 5 patients in our operation. This was seen in 5 patients in our series.series.


The commonest surgical procedure practised in our series The commonest surgical procedure practised in our series and the procedure we advocate is a cholecystectomy and the procedure we advocate is a cholecystectomy with common bile duct exploration, dilatation, with common bile duct exploration, dilatation, sphincteroplasty and internal splintage, with a tube by sphincteroplasty and internal splintage, with a tube by Rodney Smith's technique.We prefer to leave the splint in Rodney Smith's technique.We prefer to leave the splint in position for a minimum period of one year. Advantages of position for a minimum period of one year. Advantages of biliary splintage include obtaining bile for repeated biliary splintage include obtaining bile for repeated cultures, regular washes of the biliary tree, cultures, regular washes of the biliary tree, cholangiograms, prevention of recurrence of obstruction, cholangiograms, prevention of recurrence of obstruction, dilatation and for non3perative treatment of dilatation and for non3perative treatment of residual/recurrent stones. The longer the tube remains in residual/recurrent stones. The longer the tube remains in situ, the better are the results.[situ, the better are the results.[


Cholecystostomy is claimed to be a useful Cholecystostomy is claimed to be a useful procedure for biliary drainage in moribund procedure for biliary drainage in moribund patients with severely impaired liver function. patients with severely impaired liver function. However, in our experience it has proved to However, in our experience it has proved to be an unsuitable procedure for long term be an unsuitable procedure for long term decompression as the oedematous cystic decompression as the oedematous cystic duct prevents adequate drainage.duct prevents adequate drainage.


Choledochal cysts can be treated in several ways.We Choledochal cysts can be treated in several ways.We have treated one case of fusiform Choledochal cyst have treated one case of fusiform Choledochal cyst of CBD successfully by choledochoduodenostomy of CBD successfully by choledochoduodenostomy with a splint across the anastomosis which was with a splint across the anastomosis which was removed after one year. Biliary enteric anastomosis removed after one year. Biliary enteric anastomosis (gall bladder or CBD with duodenum or jejunum) are (gall bladder or CBD with duodenum or jejunum) are frequently employed for bypassing lower CBD frequently employed for bypassing lower CBD obstruction.However, an internal anastomosis has obstruction.However, an internal anastomosis has the disadvantage of getting blocked, leaking into the the disadvantage of getting blocked, leaking into the peritoneal cavity and a high incidence of ascending peritoneal cavity and a high incidence of ascending cholangitis. cholangitis.


Most of the malignancies presented late when Most of the malignancies presented late when inoperable in our series, hence radical surgery inoperable in our series, hence radical surgery was not done (except in 2 cases). Major was not done (except in 2 cases). Major resection of the nature of Whipples' operation resection of the nature of Whipples' operation (pancreatico-duodenectomy has been (pancreatico-duodenectomy has been described with good results in early cases. We described with good results in early cases. We had one case each of Whipple's operation and had one case each of Whipple's operation and hemihepatectomy. Both succumbed in the hemihepatectomy. Both succumbed in the postoperative period.postoperative period.


The high incidence of complications, increased The high incidence of complications, increased mortality and morbidity could be explained by mortality and morbidity could be explained by advanced age, poor cardiac/ advanced age, poor cardiac/ pulmonary/hepatic,/renal function and pulmonary/hepatic,/renal function and associated biliary sepsis. Tolerance to major associated biliary sepsis. Tolerance to major surgical procedures is poor. Surgery of surgical procedures is poor. Surgery of obstructive jaundice therefore continues to be a obstructive jaundice therefore continues to be a challenge.challenge.

ContentsContents

Introduction Introduction Symptoms Causes Videos Treatments Research Forums and Boards Full Contents list

IntroductionIntroduction

Condition where blockage of the flow of bile Condition where blockage of the flow of bile from the liver causes overspill of bile from the liver causes overspill of bile products into the blood and incomplete products into the blood and incomplete bile excretion from the body. More detailed bile excretion from the body. More detailed information about the information about the symptoms, , causes, , and treatments of Obstructive Jaundice is and treatments of Obstructive Jaundice is available below. available below.

What are the causes of JaundiceWhat are the causes of Jaundice??

Some of the possible causes of Obstructive Some of the possible causes of Obstructive Jaundice include: Jaundice include:

Gallstones - most common cause Gallstones - most common cause

Pancreatic cancer Pancreatic cancer

Hepatitis Hepatitis

Drugs/medications Drugs/medications

Interstitial liver diseases Interstitial liver diseases

What are the symptoms of Obstructive What are the symptoms of Obstructive JaundiceJaundice? ?

Some of the symptoms of Obstructive Some of the symptoms of Obstructive Jaundice include: Jaundice include:

Dark coloured urine Dark coloured urine

Pale stools Pale stools

Yellow colouration of skin and eyes Yellow colouration of skin and eyes

Itchy skin Itchy skin

Fever Fever

What treatments are available for What treatments are available for Obstructive JaundiceObstructive Jaundice? ?

Surgical removal of obstruction - generally Surgical removal of obstruction - generally keyhole (laparascopic) surgery or ERCP keyhole (laparascopic) surgery or ERCP

Cease drugs suspected to be causing liver Cease drugs suspected to be causing liver inflammation - e.g. steroids, sulfonylureas inflammation - e.g. steroids, sulfonylureas

Antibiotics Antibiotics

Liver transplantation Liver transplantation

Jaundice Dr. Ahmed Kensarah. Introduction Surgical obstructive jaundice (jaundice due to intra- or...

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