Obstructive jaundice Flashcards
What causes obstructive jaundice
Blocked drainage of bile
What can cause this blocked drainage of bile
- Gallstones
- Extra-luminal (pancreatic cancer, pancreatic cysts)
- Intraluminal- cholangiocarcinoma
What are some symptoms of obstructive jaundice
Jaundice
Itching
Dark urine, pale stool
Nausea and vomiting
What is Courcoisier sign
Painless jaundice
Palpable gallbladder
Name the 3 steps of bilirubin metabolism
Hepatic uptake
Conjugation
Excretion
Where and how is bilirubin conjugated
Conjugated with glucaronic acid by hepatocytes in the liver
What happens to conjugated bilirubin
It is secreted into bile and passes into the gut
What happens to conjugated bilirubin in the small intestine
Converted to urobilogen by gut bacteria
What makes faeces brown
Stercoblin
Is conjugated bilirubin water soluble
Yes
What is the difference between conjugated and unconjugated bilirubin
Unconjugated is insoluble, does not enter the urine whereas conjugated does.
What is cholangitis
Obstructive jaundice with infection
What are the main symptoms of cholangitis
Charcot’s triad:
- Fevers/ rigors
- Jaundice
- RUQ pain
What does Couvoisier sign show
Cholangitis
How do you treat cholangitis
- Treat the infection with fluids and abx
- Stop the blockage with ercp
- Stop the blockage recurring- resection/ cholecystectomy
