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Y3R6: Surgery I 👨‍⚕️ > L13: Obstructive Jaundice > Flashcards

L13: Obstructive Jaundice Flashcards

1
Q

Def of Obstructive Jaundice

A

Jaundice that occurs due to obstruction to the outflow of bile.

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2
Q

Another Name of Obstructive Jaundice

A

It is also called Surgical Jaundice, Since these cases are managed by surgical intervention.

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3
Q

Indications of surgery in Jaundice

A

Obstructive Jaundice & Some Hemolytic Jaundice require spleenectomy

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4
Q

Causes of Obstructive Jaundice

A
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4
Q

Lumen Causes of Obstructive Jaundice

A
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5
Q

Wall Causes of Obstructive Jaundice

A
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6
Q

External Causes of Obstructive Jaundice

A
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7
Q

Benjamin Classification of Biliary Obstruction

A
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8
Q

Type 1 (Complete Obstruction)

A
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9
Q

Type 2 (Intermittent Obstruction)

A
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10
Q

Type 3 (Chronic Complete Obstruction)

A
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11
Q

Type 4 (Segmental Obstruction)

A
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12
Q

CP of Obstructive Jaundice

A
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13
Q

From the clinical point of view, 90% of cases of obstructive jaundice are due to either

A
  1. Stones.
  2. Periampullary carcinoma or carcinoma of the head of the pancreas.
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13
Q

Charcot’s Triad & Reynold Pentad in Obstructive Jaundice

A
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14
Q

Courvoisier Law

A
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15
Q

Exceptions to Courvoisier’s Law

A
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16
Q

Clinical Features of Gall Bladder Mass

A
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17
Q

DDx of OJ

A

Differentiate between stone in the CBD & Periampullary Carcinoma/Cancer head of pancreas (See Pancreatic Neoplasms Lecture Page 7).

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18
Q

Lab INVx in Obstructive Jaundice

A
  • LFTs
  • Others
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19
Q

LFTs in Obstructive Jaundice

A
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20
Q

Why prothrombin time is prolonged in obstructive jaundice?

A
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21
Q

How to Correct prothrombin time in obstructive jaundice?

A

Parenteral administration of vitamin K (deep intramuscular) For 5-7 days will correct prothrombin time in patients with OJ.

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22
Q

Urine Urobilinogen in OJ

A

Negative

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23
Q

HB% in OJ

A

Decrease in malignancy

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24
Q

TC & DC in OJ

A

Increase in Infections

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25
Q

Other Labs in OJ

A
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26
Q

Imaging in OJ

A
  • Abdominal US
  • Triphasic CT
  • MRCP
  • EUS
  • ERCP
  • Angiography
  • FDG PET Scan
  • Laparoscopy
  • PTC
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27
Q

Significance of US in OJ

A
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28
Q

Indications of US in OJ

A

The initial test should be an abdominal ultrasound

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29
Q

Advantages of US in OJ

A

The most useful, noninvasive, reliable & quick investigation For obstructive jaundice

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30
Q

Role of US in Evaluation of OJ

A
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31
Q

Dilated Biliary Radicals by US in OJ

A
  • Both intrahepatic and extrahepatic can be demonstrated.
  • It’s First clue in obstructive jaundice
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32
Q

Stones by US in OJ

A
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33
Q

What is US sensitive to in OJ? and what is it not sensitive to?

A
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34
Q

Pancreatic Lesions by US in OJ

A
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35
Q

Liver Lesions by US in OJ

A

US can detect muitiple secondaries in the liver, thus,
favoring the diagnosis of malignancy.

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36
Q

LNs By US in OJ

A

Endosonogram can detect lymph nodes also.

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37
Q

Indications of Triphasic CT in OJ

A
  • For Painless jaundice, since the suspicion for malignancy is high, the next study of choice is a “triple-phase” abdominal CT scan as ultrasound cannot rule out pancreatic lesions.
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38
Q

Phases of Triphasic CT

A

Triple phase CT captures images during three phases of contrast:
1. Arterial phase
2. Early venous phase
3. Late venous phase.

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39
Q

Clinical Findings by Triphasic CT in OJ

A
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40
Q

What Indicates Operability in Triphasic CT in OJ?

A
  • Obliteration of fat plane between the mass and superior mesenteric vessels which decides the operability.
  • It can also detect coeliac nodes, presence of which is a contraindication for radical resections.
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41
Q

Limitations of Triphasic CT in OJ

A

CTscan cannot differentiate head mass of carcinoma FROM chronic pancreatitis (PET scen may differentiate).

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42
Q

Precaution of Triphasic CT in OJ

A

Take precautions Against contrast induced nephropathy.

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43
Q

Indications of MRCP in OJ

A

It is the investigation of choice in cases of obstructive jaundice or of high strictures and cholangiocarcinomas.

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44
Q

Advantages of MRCP in OJ

A
  • It is non-invasive.
  • Delineates the bile ducts very well so that a biliary bypass can also be planned.
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45
Q

Disadvantages of MRCP in OJ

A

Biopsy is not possible with MRI.
- While Brush cytology is possible while doing ERCP

46
Q

Findings in MRCP in OJ

47
Q

Advantages of EUS in OJ

47
Q

Significance of EUS in OJ

A

EUS is a useful adjunct that is utilized in some centers

48
Q

If CT/EUS does show a pancreatic mass suspicious for malignancy, FNA/biopsy is ……… if patientis a surgical candidate

A

not necessary

49
Q

Indications of ERCP in OJ

50
Q

Routine ERCP is not indicated in patient with obstructive jaundice due to carcinoma head pancreas or periampullary carcinoma

51
Q

Interpretation of ERCP in OJ

52
Q

Complications of ERCP in OJ

53
Q

Uses of ERCP in ERCP in OJ

54
Q

Uses of ERCP in ERCP in OJ

  • Stones
55
Q

Uses of ERCP in ERCP in OJ

  • Cholangitis with OJ
56
Q

Uses of ERCP in ERCP in OJ

  • Biliary Strictures
57
Q

Uses of ERCP in ERCP in OJ

  • Chronic Pancreatitis
58
Q

Role of Preoperative Biliary Stenting

59
Q

Indications of Preoperative Biliary Stenting

A
  1. Cases require palliation of jaundice in advance cases.
  2. When neoadjuvant chemotherapy is indicated before surgical treatment is considered.
60
Q

Angiography is not routinely required in OJ, Why?

A

As good quality contrast CT scan may show any invasion of vessels by pancreatic growth.

61
Q

Findings of Angiography in OJ

A
  1. Angiographic appearance of occlusion of celiac, superior mesenteric vessels or portal vein suggests non-resectability.
  2. Distortion of the vessels is commonly seen.
62
Q

What is FDG PET Scan?

A

Fludeoxyglucose-18 (FDG) Positron Emission Tomography (PET)

63
Q

Indications of FDG PET Scan

64
Q

Advantages of FDG PET Scan

A

FDG PET scan combined with CT scan is able to differentiate between benign & malignant pancreatic lesion

65
Q

Disadvantages of FDG PET Scan

A

Inflammatory lesion in pancreas may show false positive results.

66
Q

Role of Laparoscopy in OJ

67
Q

Indications of Laparoscopy in OJ

68
Q

Experienced laparoscopists are also trying biliary and gastric bypass laparoscopically.

69
Q

Role of Percutaneous Transhepatic Cholangiography (PTC) in OJ

70
Q

Indications of Percutaneous Transhepatic Cholangiography (PTC) in OJ

71
Q

More inuestigations to assess the patient for fitness for GA

72
Q

Preoperative Preparation in OJ

73
Q

Preoperative Preparation in OJ

  • Anemia
A

The patient isusually anemic

  • If Hb level < 10 gm%: correction of anemia by preoperative blood transfusion.
74
Q

Preoperative Preparation in OJ

  • ## Hepatocellular Dysfunction
75
Q

Preoperative Preparation in OJ

  • Chronic Dysfunction
76
Q

Preoperative Preparation in OJ

  • Impaired renal Function
77
Q

Preoperative Preparation in OJ

  • Prolonged PT
A

may be corrected with an injection of vitamin K for 5-7 days before the operation.

78
Q

Preoperative Preparation in OJ

  • Infection
79
Q

Preoperative Preparation in OJ

  • Malnourishment
A

Enteral or parenteral nutrition may be given preoperatively.

80
Q

Preoperative Preparation in OJ

  • Pulmonary Function
81
Q

Algorithm of Managment of OJ

82
Q

When to suspect OJ by labs?

82
Q

Initial Radiological Study in OJ? and why is it used?

A

USG Abdomen

  • for Cause & Level of Block
83
Q

Look for any mass lesion in head of pancreas or evidence of chronic Pancreatitis by ….

83
Q

Lesion in periampullary region is detected by ….

A

UGI Endoscopy

84
Q

How to Conrirm Lesion in periampullary region?

85
Q

History of CBD Stones

85
Q

Types Of CBD Stones (In terms of Site)

A
  • Primary & Secondary
86
Q

Site of Primary Stones

87
Q

Nature of Primary Stones

88
Q

Causes of Primary Stones

89
Q

Nature of Secondary Stones

90
Q

Site of Secondary Stones

91
Q

Aim in Calcular Obstructive jaundice

A
  1. To relieve biliary obstruction by removal of stones from CBD.
  2. To remove the gall bladder (if present), that is usually the source of CBD calculi.
92
Q

Managment options in Calcular Obstructive jaundice

93
Q

Management Of CBD Stones With Cholangitis

94
Q

Management Of CBD Stones Without Choiangitis

  • If the GB Contains Calculi
95
Q

Management Of CBD Stones Without Choiangitis

  • If the Gallbladder Contains NO Calculi
A
  1. ERCP extraction.
  2. ESWL (Extracorporeal shock wave lithotripsy).
96
Q

Management Of CBD Stones Without Choiangitis

  • In case of retained stone
97
Q

Management of Malignant Obstructive Jaundice

  • Benign Strictures (Low CBD Obstruction)
98
Q

Management of Malignant Obstructive Jaundice

  • Benign Strictures (High CBD Obstruction)
99
Q

Management of Malignant Obstructive Jaundice

  • Periampullary Carcinoma
100
Q

Surgical Treatment of periampullary carcinoma

101
Q

Nonsurgical Treatment of periampullary carcinoma

102
Q

Which Has better Prognosis, Periampullary Carcinoma & Carcinoma head of pancreas?

A

Periampullary Carcinoma

103
Q

Management of Malignant Obstructive Jaundice

  • Sclerosing Cholangitis
A
  1. Steroids in large doses.
  2. Cholestyramine.
  3. Stenting.
104
Q

Management of Malignant Obstructive Jaundice

  • Cholangiocarcinoma
A
  1. Stenting for relief of jaundice
  2. Chemotherapy: Not much helpful Klatskin tumor.
105
Q

What is Klatskin tumor?

A

It is cholangiocarcinoma at the confluence of the hepatic ducts.

106
Q

TTT of Klatskin tumor

A
  • Treatment is similar to cholangiocarcinoma.
107
Q

Management of Malignant Obstructive Jaundice

  • Carcinoma Gallbladder
108
Q

Post-Operative Managment of OJ

109
Q

Done

Y3R6: Surgery I 👨‍⚕️ (36 decks)

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