Obstructive Jaundice Flashcards
Label this diagram with the possible conditions/ disease at each point that can happen that cause obstructive jaundice.
What questions can you ask a patient to confirm the probably cause a their jaundice?
Clearly confirm his history yourself
Is the colicky pain associated with eating fatty food?
Was his jaundice of sudden onset or gradual onset?
Has his jaundice fluctuated or has it got progressively worse?
Has he had a fever or rigors?
Specifically ask the patient about dark-coloured urine, pale stools, pruritus and weight loss or weight gain.
FHx of anaemia, splenectomy & gallstones.
What blood tests/ tests should you do for someone with possible obstructive jaundice?
- liver function tests
- serum amylase
- prothrombin time
What results from the liver function test would confirm obstructive jaundice?
↑bilirubin [conjugated]; ↑ Alkine Phosphatase; mildly ↑ed transaminases [ALT & AST]; ↑γGT).
What are the most appropriate radiological investigations (in order of relevance) for obstructive jaundice?
An US Scan first
- MRCP next (if US not good)
- CT scan to exclude another cause
Imaging subsequently confirmed common bile duct gallstones. What treatment options should be discussed to relieve his jaundice?
If the patient remains well, his jaundice fails to spontaneously resolve, and there is confirmation of gallbladder stones and CBD stones -laparoscopic cholecystectomy and simultaneous CBD exploration.
Most centres would proceed to an ERCP then offer a laparoscopic cholecystectomy after discharge when the patient has recovered.
Occasionally it proves impossible to remove the CBD stones endoscopically – laparoscopic/open cholecystectomy with CBD exploration is offered
What is meant by colicky pain?
severe abdominal pain caused by wind or intestinal obstruction; squeezing pain; move to reduce discomfort
What are signs of obstructive jaundice?
jaundice, pale stool, dark urine, colicky pain, epigastric pain, reduced liver functions test
