Obstructive jaundice is a condition characterized by the accumulation of bilirubin in the blood due to an obstruction in the bile ducts. The bile ducts are responsible for transporting bile, a yellowish-green fluid produced by the liver, to the intestines to aid in digestion. When the flow of bile is hindered or blocked, bilirubin, which is a waste product of red blood cells, cannot be properly eliminated from the body, leading to its accumulation in the bloodstream.
The most common cause of obstructive jaundice is the presence of a blockage in the bile ducts, usually caused by gallstones, tumors, or strictures (narrowing) of the ducts. This blockage prevents bile from flowing freely, resulting in its buildup in the liver and subsequently in the blood. As a result, individuals with obstructive jaundice may exhibit yellowing of the skin, eyes, and mucous membranes, which is the hallmark symptom of jaundice.
3. Jaundice is a yellow discoloration of skin,sclera and
mucous membrane.
Jaundice is usually detectable clinically when the
plasma bilirubin exceeds 2.5mg/dl.
7. INTRA-MURAL TRANS-MURAL EXTRA-MURAL
• CBD Stones
• Parasite(Ascariasis)
• Cholangiocarcinoma
• Choledochal Cyst
• Strictures
• Ca Head of Pancreas
• Peri Ampullary Tumor
• Mirizzi’s Syndrome
8. TYPE I
(Complete
Obstruction)
TYPE II
(Intermittent
Obstruction)
TYPE III
(Chronic
Incomplete
Obstruction)
TYPE IV
(Segmental
Obstruction)
• CA Head of
pancreas
• Ligation of CBD
• Cholangiocarci
noma
• Parenchymal
Liver Disease
• Choledocholith
iasis
• Periampullary
Tumor
• Duodenal
Diverticula
• Choledochal
Cyst
• Intra biliary
parasite
• Sticture of CBD
• Cystic fibrosis
• Chronic
pancreatitis
• Stenosed Biliary
enteric
anastmosis
• Traumatic
• Sclerosing
Cholangitis
• Intra Hepatic
Stones
• Cholangiocarci
noma
9. Itching
Abdominal Pain
Dark urine
Pale stools
Weight loss
Fever
Dry eyes
Jaundice
Fatigue
10. Complains of yellow skin , eyes ,pale stools ,dark urine
,jaundice and pruritis
Patient’s Age
Presence or Absence of pain
Location of pain
Systemic symptoms (fever, anorexia , weight loss)
History of Anemia
Previous malignancy
Known gall stone disease
Hepatitis
Previous biliary surgery
Use of Alcohol , drugs , medications
11.
12. SITE FINDINGS
FACE Jaundice
xanthelasma
HANDS Clubbing
Leukonychia
CHEST Spider navi
Left supraclavicular lymph nodes
Abdomen inspection Scars
Distension
Caput medusae
Abdomen palpation/percussion Hepatomegaly
Splenomegaly
Ascites
Palpable gallbladder
LEGS Edema
13. This law states that a painless palpably enlarged
gallbladder accompanied with mild jaundice is
unlikely to be caused by gallstones.
14. TEST HEPATOCELLULAR OBSTRUCTIVE
Conjugated bilirubin Mild elevation Marked increased
Urine urobilinogen Normal Absent
AST Marked elevation Mild elevation
ALT Marked elevation Mild elevation
ALP Mild elevation Marked elevation
GGT Mild elevation Marked elevation
17. PATHOLOGY FINDING
Cholelithiasis Radio oapaque stones
Radiolucent gas in stone Mercedes-Benz sign
Porcelain gallbladder Calcification of GB
Emphysematous cholecystitis Gas in wall of GB
Speckled(spotty) calcification Chronic pancreatitis
18. CHOLELITHIASIS
STONES IN CBD
Dilation of CBD at the same level as portal
vein(Dubble-Barrel sign)
CBD dilation
Cholangiocarcinoma
Ca head of pancreas
19. EUS usg have 98% acurracy in patients with
obstructive jaundice.
It allows sampling via eus guided fine needle
aspiration.
Dilation of CBD
Cholangiocarcinoma
Ca head of pancreas
20. SPIRAL CT SCAN
CT cholangiography by helical ct scan
MRCP is non invasive way to visualize hepatobiliary
tree.
It can detect biliary and pancreatic duct stone
,strictures , and dilatations in billiary tree.
21.
22. Endoscopy plus fluoroscopy =ERCP
It is an invasive procedure
Has diagnostic and therapeutical potential
Allows biopsy or brush cytology
Allows stenting for stricture
23.
24. PTC is performed by radiologist using flouroscopic
guidence.
The liver is punctured to enter the peripheral intra
hepatic bile duct system.
It can be used to drain biliary obstruction.
28. It is defined as renal failure in patients with advance
cirhosis and ascites.
DIAGNOSTIC CRITERIA
A. Cirhosis with ascites
B. Creatinine >1.5 mg/dl
C. No shock
D. No nephrotoxic drug use
E. No organic kidney disease
F. No improvement in creatinine after discontinuing
diuretics and volume expansion (1g/kg/d of albumin
for 2 days)
29.
30. TYPE I HRS
Rapidly progressive
Poor prognosis
Creatinine >2.5mg/dl
TREATMENT
Octreotide
Midodrine
Albumin infusion
Terlipressin
Liver transplant
Steady deterioration
Better prognosis
TREATMENT
TIPSS
TYPE II HRS
31. Ursodeoxycholic acid (10mg/kg/d)
Cholestyramine (4g in glass of water three times a day)
Antihistamine
Vitamin k
5 or 10% dextrose water
Prophylactic antibiotics to prevent cholangitis
Keep the patient over hydrate
32. Broad spectrum antibiotics
Parentral vitamin k
Antihistamine
Nutritional support
Hydration
Pre operative biliary drainage
33. It can be achieved by internal or external approach.
Internal biliary drainage is achieved by endoscopic
placement of a biliary stent and endoscopic
sphincterotomy.
External biliary drainage is performed via flouroscopic
guided percutaneous trans-hepatic approach.
If the levels of bilirubin is more than 5mg/dl and
duration of jaundice is more than 3 weeks then
drainage improves liver function so that major
operation can be performed without major
complications.
34. CAUSE TREATMENT
Cholelithiasis • Open cholecystectomy
• Laproscpic
cholecystectomy
CBD stones • Pre operative removal
through ERCP followed
by lap cholecystectomy
• Mechanical lithotripsy
• Shock wave lithotripsy
• Open exploration of CBD
Choledocal cyst • Excision
• Hepaticojejunostomy
Chronic pancreatitis • Endoscopic
sphincterotomy
• Stent placement
• Pancreaticojejunostomy
36. Early cholecystectomy after ERCP within 72 hours has
better outcomes probably due to inflammatory
process.
The longer the interval between ERCP and LC , the
higher are the chances of complications, the risk to
conversion to open technique and increased hospital
stay.
37. Gradual reduction of weight
High intake of fibre
Reduce intake of saturated fats
Reduction in sugar intake
Regular exercise
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