11.4 - Obstructive Jaundice

Question 1

What blood tests would you do for obstructive jaundice?

Answer 1

• high conjugated bilirubin
• high alkaline phosphatase
• increased transaminases (ALT and AST)
• high gamma glutamyl transferase (GT)
• white cell count (WCC) and CRP
• serum amylase
• prothrombin time

Question 2

What are the most appropriate radiological investigations (in order of relevance)?

Answer 2

• ultrasound
• if answer is not clear, then MRCP
• if they both fail, then CT scan

Question 3

If it is caused by common bile duct gallstones, how should it be treated?

Answer 3

• offer ERCP - endoscopic retrograde cholangiopancreatography:
• distal blockage in biliary system = put tube with deflated balloon into duodenum through stomach to access ampulla
• usually blockage is stones = balloon goes behind stones, blows up then pulls stones out
• if that does not work, then laparoscopic/open cholecystectomy