OBSTRUCTIVE JAUNDICE

Question 1

Causes of post hepatitis jaundice

Answer 1

Choledocholithiasis
Periampullary tumours

Question 2

Patients with obstructive jaundice are at risk of…

Answer 2

Acute ascending cholengitis
Acute kidney injury
Bleeding disorder
Multi organ dysfunction

Question 3

Imaging in obstructive jaundice

Answer 3

U/S abdomen
CT Scan abdomen
MRCP
ERCP
PTC

Question 4

U/S abdomen in obstructive jaundice

Answer 4

Confirm biliary obstruction
Exclude or diagnose gallstones
Assess level of obstruction
Exclude ascites
Assess intra abdominal masses

Question 5

CT abdomen in obstructive jaundice

Answer 5

When U/S fails
For staging if malignancy is suspected

Question 6

MRCP in obstructive jaundice

Answer 6

When no masses are present but cause not found in other investigations

Question 7

ERCP in obstructive jaundice

Answer 7

If gallstones are found on U/S
Diagnostic and therapeutic

Question 8

PTC in obstructive jaundice

Answer 8

When gallstones are found on U/S but more suitable for proximal obstruction
Diagnostic and therapeutic

Question 9

Intraluminal causes of obstructive jaundice

Answer 9

Gallstones, foreign body, ascariasis

Question 10

Benign causes of obstructive jaundice (bile duct stricture)

Answer 10

Chronic pancreatitis
Bile duct injury
Primary sclerosing cholangitis

Question 11

Malignant causes of obstructive jaundice (bile duct stricture)

Answer 11

Head of pancreas cancer
Cholangiocarcinoma
Ampullary carcinoma

Question 12

Extraluminal causes of obstructive jaundice

Answer 12

Benign pancreatic or liver masses
Enlarged periportal lymph nodes

Question 13

Rx of obstructive jaundice

Answer 13

1.Resuscitation if needed
2.Rx complication
3.Biliary compression via ERCP or PTC. Removal of gallstones or stenting of bile duct to re-establish flow
4.Surgery

Question 14

When is surgery indicated in obstructive jaundice

Answer 14

If endoscopic or percutaneous biliary decompression fails or resectable malignancy is the cause of biliary obstruction

Question 15

Complications of obstructive jaundice

Answer 15

Acute ascending cholangitis
Coagulation disturbances
Acute kidney injury

Question 16

Rx of acute ascending cholangitis

Answer 16

1. Resuscitation
   2.Antibiotics
2. Analgesics
3. Diagnostic imaging
4. Biliary decompression

Question 17

Diagnosis of acute ascending cholangitis

Answer 17

Charcot’s triad

Question 18

Coagulation disturbances in obstructive jaundice

Answer 18

Raised INR d/t lack of Vitamin K dependant coagulation factors.
Malabsorption of vitamin K occurs because it is fat soluble.
Fat malabsorption occurs because there is lack of bile in the intestines.