Obstructive jaundice

Question 1

What questions should you ask to confirm the probable cause of jaundice?

Answer 1

*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.

Question 2

What other blood tests should you
ensure are requested in someone with obstructive
jaundice?

Answer 2

• Serum Amylase
• Prothrombin time

Question 3

What are the most appropriate
radiological investigations (in order of relevance) for someone with OJ?

Answer 3

*An US Scan first
* If the answer isn’t clear on the US Scan - MRCP next
* If an US Scan & MRCP fail to reveal a cause - CT scan to exclude another
cause.

Question 4

Imaging subsequently confirmed
common bile duct gallstones. What treatment
options should be discussed to relieve his
jaundice?

Answer 4

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