obstrctive jaundice -نوري Flashcards
What is jaundice
The yellowish discoloration of skin, sclera and mucous membrane that results from excessive deposition of bilirubin in tissues
Jaundice develops when S. bilirubin levels
- S. bilirubin levels >2 mg/dl (34.2 μmol/L).
Typically can be detected
-if S. bilirubin level above 3 mg/dl (51.3 μmol/L).
Jaundice can be categorized as
Pre-hepatic,
Hepatic,
Post-hepatic.
- what’re the causes of the Biliary obstruction (CBD or CHD) ?
or obstrctive jaundice
1-intra-luminal
2-intra-mural
3-extra-luminal
what’re the causes of the intra-luminal?
1.CHD or CBD stone
2. Daughter cyst (intabiliary rupture
of liver hydatid
what’re the causes of the intra-mural?
- Cholangiocarcinoma
- Coledochal cyst
- stricture
4 .Biliary atresia in neonate
- Primary schlerosing Cholangitis
what’re the causes of the extra-luminal ?
- Carcinoma of head pancreas
- Chronic pancreatitis
- Liver cancer or metastatic cancer
- Periampulary tumor or cancer (duodenal)
- Occasionally acute cholecystitis
( gall stone complication) - Ca gall bladder
Approach of pt with obstructive jaundice ?
- History
- Exam.
- Investigation
history of pt with obstructive jaundice ?
- Duration
- Onset, progression and depth
- Itching, Change in color of urine and stool
- Pain, fever ( high or low grade fever)
- Furtther GI symptoms : Nausea, vomiting, haematemesis, melena, abdominal distension…..etc
- Other systemic symptoms: : oliguria, change in consciousness, bruises
- History of haemolytic disease (SCA, Thalascemia)
- Blood transfusion
- Previous similar attcks
- Previous surgery like liver surgey (hydatid) or biliary surgery (Lap cholecystectomy)
- Any chronic liver disease or chronic bowel disease
- Family history of jaundice
- Alcohol
- Further social history: uncovered sexual life or contact with affected patients like doctors and multiple recent travels
- Drug history like rifampicin
Examination of pt with obstructive jaundice ?
1. General Examination Confirm icterus by exam. of eye, MM (technical term for jaundice.) Depth of jaundice Palor and Dehydration Bruise Vital Signs (Temp & PR)
- Signs of chronic liver disease:
Xanthelasma, Spider naevi, Gynaecomastia, Dupuytren’s Contracture, Clubbing of fingers - Ordinary Abdominal Examination
Dilated veins, Abdominal distention (Ascitis)
Liver: Size, Shape, Surface
Enlargement of gall bladder (Corvoisier’s law positive or negative)
Splenomegaly
Abdominal mass
Others
lab diagnosis of the obstrctive jaundice ?
1-total bilirubin increasesd 2-Direct increased conjecated 3-urobilonogen decrese 4-urine dark and stool is bale 5- high ALK 6- direct in the urine s 7- spleenomegly only in hepatic
what’re investigation of the post hepatic obstrctive jaundice ?
- LFT
- Ultrasonography
- MRCP+/- CT Scan
+ERCP:
Diagnostic and Therapeutic such as sphincterotomy, stone removal and stenting
PTC
in case of failure of ERCP
Such as in some cases of cholangiocarcinoma
what’re treatment of the post hepatic obstrctive jaundice ?
1- supportive mangment
Fluid & electrolytes
Correction of coagulation defects (Vitamine K)
Prevention of infection (antibiotics)
Prevention of hepatorenal syndrome and hepatic encephelopathy (IV fluid and duiretic)
- Surgical treatment
Surgical treatment of the post hepatic obstrctive jaundice ?
- ERCP
- Surgery:
A. Supraduodenal choledochotomy stone removal
B- Transduodenal sphineterotomy & stone Extraction - Cholangitis should be treated as mentioned above
when we do Transduodenal sphineterotomy ?
when the stone in the distal of the CBD so need to form an opening to reach it then we suture this opening
