JAUNDICE Index Case Term 2. Jaundice Definition Causes History Investigation-Imaging Clinical Cases.
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Transcript of JAUNDICE Index Case Term 2. Jaundice Definition Causes History Investigation-Imaging Clinical Cases.
JAUNDICE
Index Case Term 2
Jaundice
•Definition•Causes•History• Investigation-Imaging•Clinical Cases
Definition
• Jaundice is a yellowing of the skin, conjunctiva and mucous membranes caused by hyperbilirubinaemia.
Anatomy
Causes
• excess bilirubin production (Haemolysis)• impaired uptake by the hepatocyte
(hepatocellular jaundice)• failure of conjugation (hepatocellular jaundice)• impaired secretion of conjugated bile into the
bile canaliculi (hepatocellular jaundice)• impairment of bile flow subsequent to
secretion by the hepatocyte (obstructive or cholestatic jaundice)
Obstructive Jaundice• Common
– Common bile duct stones– Carcinoma of the head of pancreas– Malignant lymph nodes at the porta hepatis
• Infrequent– Ampullary carcinoma– Pancreatitis– Liver secondaries
• Rare– Benign strictures - iatrogenic, trauma– Recurrent cholangitis– Mirrizi's syndrome– Sclerosing cholangitis– Cholangiocarcinoma– Bilary atresia– Choledochal cysts
History
• Abdominal pain, weight change, fever• Drug history• Injections• Alcohol• Transfusion blood, blood products• Contact with jaundiced individuals• Sexual activity• Ingestion raw shellfish, wild mushrooms
NN+Haemolytic
++++++Hepatocellular
+++++++Cholestatic
AlkPTransaminases
Bilirubin
Liver Function Tests
Jaundice
•Clinical Case 1
• 50 year old female• Acute, severe pain in RUQ• Nausea and vomiting• Calls GP – pethidine pain relief• Next few days notices dark urine and
pale stools• Her husband comments she has a pale
yellow tinge
Emergency admission
• What investigations would you do ?
• What results would you expect?
Abdominal Ultrasound showing multiple gallstones in gallbladder
US shows stone in Common Bile Duct
MRCP showing stone in Common Bile Duct
ERCP showing stone in Common Bile Duct
Case 1
• Obstructive jaundice due to gallstone in common bile duct
• Blood tests show high bilirubin and high alkaline phosphatase
• Urine contains bilirubin• Treatment includes ERCP to
remove stone and then plan Cholecystectomy
Clinical Case 2
• 65 year old female• Loss of appetite and weight loss• Develops jaundice and itching• Scratch marks and bruising• Liver enlarged, palpable gallbladder
Emergency admission
• What investigations and what results?
Abdominal Ultrasound
• Dilated common bile duct measuring 14mm
• Obstruction at lower end of bile duct
• Cause not clear on US
CT Abdomen
• Mass in head of pancreas
• Obstruction of common bile duct
• Liver metastasis• Peritoneal disease
and ascites
Endoscopic Ultrasound showing mass in head of pancreas
obstructing the CBD
EUS Biopsy of pancreatic mass
Diagnosis
• Histology of pancreatic biopsy shows adenocarcinoma.
• Not suitable for surgery as already spread to other organs eg peritoneum
• Relieve jaundice and consider chemotherapy
Therapeutic ERCP
• Put guide wire across the obstruction of CBD
• Insert bilary stent• Relieves jaundice
and some of symptoms
In Summary
• Anatomy• Disease processes that cause
jaundice • 2 Clinical cases of obstructive
jaundice• Thought about investigation of
jaundiced patient