Obstructive Jaundice

BYANIEDU, UGOCHUKWU .I.CR1

OBSTRUCTIVE JAUNDICE

OutlineIntroductionPathophysiology CausesClinical presentationInvestigationComplications TreatmentReferences

IntroductionObstructive jaundice is a condition in which there is blockage of the flow of bile out of the liver to the intestine. This results in redirection of excess bile and its by-products into the blood, and bile excretion from the body is incomplete. Bile contains many by-products, one of which is bilirubin, a pigment derived from dead red blood cells. Bilirubin is yellow, and this gives the characteristic yellow appearance of jaundice in the skin, eyes, and mucous membranes.

Pathophysiology

Bile is the exocrine secretion of the liver and is produced continuously by hepatocytes. It contains cholesterol and waste products, such as bilirubin and bile salts, which aid in the digestion of fats. Half the bile produced runs directly from the liver into the duodenum via a system of ducts, ultimately draining into the common bile duct (CBD). The remaining 50% is stored in the gallbladder. In response to a meal, this bile is released from the gallbladder via the cystic duct, which joins the hepatic ducts from the liver to form the CBD. The CBD courses through the head of the pancreas for approximately 2 cm before passing through the ampulla of Vater into the duodenum

5

Biliary obstruction refers to the blockage of any duct that carries bile from the liver to the gallbladder(intrahepatic) or from the gallbladder to the small intestine(extrahepatic). This can occur at various levels within the biliary system.

CausesCalcular: Gall bladder stones passing through cystic duct to obstruct the common bile duct.

Malignancy: - Cancer head of the Pancreas. - Cholangiocarcinoma. E.g Klatskin tumor

Clinical PresentationJaundice ( Yellowish sclera and skin ) ItchingPain(RUQ) Fever Dark urine Pale stool.

Pale stool and dark urine

InvestigationLaboratory: -Total bilirubin and Direct bilirubin(Conjugated) Direct bilirubin more elevated than indirect. - Liver Enzymes elevated. - Hepatitis Markers (A, B & C). - Coagulation Profile : Increased PTT.

Radiological:-Ultrasound Abdomen showing dilated CBD + stones. > 7mm in diameter- CT and MRI Abdomen showing pancreatic tumor and liver metastasis.- ERCP (Endoscopic retrograde cholangio- pancreatography) diagnostic and therapeutic.

Complications

CholangitisCoagulopathyPancreatitisLiver cirrhosisCholestasis with pulmonary stenosis

TreatmentTreatment options for obstructive jaundice depend on the exact cause of the jaundice and on the severity of the disease. Antibiotic therapy (if indicated for infection)Endoscopic retrograde cholangiopancreatography (ERCP), an imaging procedure that allows treatment of some bile duct problems, including removal of gallstones that are causing obstructionIntravenous fluids and pain medications

Nutritional support (IV Vit K)Surgery or other procedures to repair anatomical defects or create alternative pathways for the flow of bileTransplantation of the liver (if all other methods are unsuccessful and all of the liver is damaged)Treatment for cancer, if present, which may include chemotherapy, radiation therapy or surgery such as Whipple procedure (pancreatoduodenectomy).

Referenceshttp://emedicine.medscape.com/article/187001-overview. Retrieved on 9th March, 2016http://www.healthgrades.com/right-care/digestive-health/obstructive-jaundice--treatments. Retrieved on the 10th March, 2016http://www.slideshare.net/hatemelgohary712/obtructive-jaundice?from_action=save. Retrieved on 10th March, 2016