Obstructive jaundice

Question 1

Define obstructive jaundice

Answer 1

Jaundice as a result of bile duct blockage resulting in no bile flow from the liver to the duodenum

Question 2

Name common causes of obstructive jaundice

Answer 2

1. Intraductal
   - choledocholithiasis
   - FB
   - ascaris lumbricoides
2. Intramural
   - malignant strictures (cholangiocarcinoma)
   - benign strictures (chronic pancreatitis, PSC, HIV-cholangiopathy, iatrogenic bile duct injury)
3. Extraductal
   - periampullary malignancy
   - pancreatic pseudocysts
   - malignant portal lymphadenopathy
   - benign portal lymphadenopathy

Question 3

Name the most common cause of benign portal lymphadenopathy

Answer 3

TB

Question 4

Name clinical signs of obstructive jaundice

Answer 4

Icterus
Acholic stool
Dark urine

Question 5

Name complications of obstructive jaundice

Answer 5

Acute cholangitis
Pruritis
Coagulopathy
Acute renal failure

Question 6

What is the normal diameter of the common bile duct?

Answer 6

<7mm

Question 7

Name investigations for obstructive jaundice

Answer 7

Abdominal U/S

Bloods (LFTs, INR, UKE, FBC, CRP)

Question 8

What bilirubin results are diagnostic of obstructive jaundice?

Answer 8

Total bilirubin >20umol/L

CB >70% total bilirubin

Question 9

Name indications for urgent biliary tree drainage

Answer 9

Moderate-severe acute cholangitis
Non-resolving acute renal dysfunction
Pruritis
Bleeding despite vitamin K therapy

Question 10

Name methods of biliary drainage

Answer 10

ERCP
PTC -> PTBD 
Transhepatic cholecystostomy tube 
Bilio-enteric anastomosis 
- hepatic jejunostomy
- cholecystojejunostomy

Question 11

What is Charcot’s triad?

Answer 11

Fever
Jaundice
Abdominal pain

Question 12

Give the Tokyo classification of acute cholangitis

Answer 12

1. Systemic inflammation
   - fever
   - raised inflammatory markers
2. Cholestasis
   - bilirubin >2mg/dL
   - raised LFTs >1.5x
3. Imaging
   - biliary duct dilation
   - evidence of stone or obstruction