Obstructive jaundice Flashcards
1
Q
what is obstructive jaundice also known as
A
cholestatic jaundice
2
Q
Define obstructive jaundice
A
when there is a mechanical blockage of bile flow from the liver to the duodenum, leading to the accumulation of conjugated bilirubin in the bloodstream.
3
Q
Clinical features of obstructive jaundice
A
- Jaundice: Yellow discoloration of the skin and sclera.
- Dark Urine: Due to increased excretion of conjugated bilirubin.
- Pale/Clay-Colored Stools: Due to the absence of stercobilin in the stool.
- Pruritus: Accumulation of bile salts.
- Abdominal Pain: Often in the right upper quadrant (RUQ) or epigastrium.
- Weight Loss and Fat Malabsorption: Due to impaired bile salt secretion.
4
Q
Causes of bbstructive jaundice can be divided into 3 categories
A
- Intraluminal causes
- Mural causes
- Extrinsic causes
5
Q
Intraluminal Causes of Obstructive Jaundice
A
- Gallstones (Choledocholithiasis) – Stones in the common bile duct (CBD).
- Mirizzi Syndrome - gallstone becomes impacted in the cystic duct or Hartmann’s pouch of the gallbladder, causing external compression of the common hepatic duct (CHD) or common bile duct (CBD)
- Biliary Sludge – Thickened bile causing partial obstruction.
- Parasites – Ascaris or Clonorchis causing obstruction.
6
Q
Mural Causes of Obstructive Jaundice
A
- Cholangiocarcinoma – Cancer arising from the bile ducts.
- Biliary Strictures – Benign or malignant strictures narrowing the bile ducts.
- Primary Sclerosing Cholangitis (PSC) – Chronic inflammation and fibrosis of the bile ducts.
- Post-surgical or Post-inflammatory Strictures – After cholecystectomy or bile duct injury.
7
Q
Extrinsic Causes of Obstructive Jaundice
A
- Pancreatic Cancer – Compression of the distal CBD by the tumor.
-
Periampullary Tumor – Tumors at the ampulla of Vater.
Enlarged Lymph Nodes (e.g., Metastatic Disease) – Compression of the bile ducts. - Chronic Pancreatitis – Fibrosis causing biliary obstruction.
8
Q
Tx for biliary strictures
A
ERCP with stenting
9
Q
Obstructive picture of LFTs
A
- sig. raise of ALP
- slightly raised ALT/AST
10
Q
Hepatic picture of LFTs
A
- sig. raise of ALT/AST
- slightly raise of ALP
10
Q
what systems are ALP assoc with
A
- Liver
- Biliary
- Bones
- Placenta (pregnancy)
11
Q
what is AST/ALT assoc. with
A
Hepatocellular injury (Liver cells damage)