Obstructive jaundice is a fairly common presentation to the emergency department and surgical teams. Take home obstructive jaundice is a huge spectrum of differentials. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. Obstructive jaundice is a medical condition caused by a blockage in the bodys biliary system that leads to a buildup of bile in the bodys bloodstream. Clinical approach to patients with obstructive jaundice.
Increase serum bilirubin due to bile outflow obstruction results in obstructive jaundice. The aim of this study is to determine the sociodemographic. Choledocholithiasis accounts for about 22% of the overall etiology of obstructive jaundice and about 73. For more than 20 years, percutaneous transhepatic biliary drainage procedures have allowed a nonsurgical approach to the management of malignant biliary obstruction. A malignant source of obstruction more often presents with painless jaundice and weight loss. Notably, intravenous feedings predispose patients to bile stasis and a clinical picture of obstructive jaundice. Its caused by a buildup of a substance called bilirubin in the blood and bodys tissues.
Caused by increased destruction of red blood cells, results in the inability to. Surgical obstructive jaundice can be lifethreatening. Jaundice and asymptomatic hyperbilirubinemia are common clinical problems that can be caused by a variety of disorders, including bilirubin overproduction, impaired bilirubin conjugation, biliary obstruction, and hepatic inflammation. Jaundice in adults can be an indicator of significant underlying disease. May 10, 2020 obstructive jaundice is a medical condition caused by a blockage in the bodys biliary system that leads to a buildup of bile in the bodys bloodstream. More importantly, it is vital to distinguish the various causes of obstructive jaundice. Feb 08, 2020 obstructive jaundice is a fairly common presentation to the emergency department and surgical teams. Choledocholithiasis is the major entity in the surgical jaundice. Investigation and management of obstructive jaundice c d briggs m peterson abstract obstructive jaundice is a medical emergency. Management comprises establishing the diagnosis, excluding pancreatic cancer, and supporting pancreatic exocrine and endocrine function.
Preoperative biliary decompression improves postoperative morbidity. Jaundice is the yellowing of the skin and whites of the eyes when the quantity of bilirubin in the blood is high. Most patients with obstructive jaundice caused by primary pancreaticobiliary malignancies and metastatic disease cannot be cured by surgical resection when diagnosed. Pathophysiological consequences of obstructive jaundice.
Painful obstructive jaundice is often associated with gallstone disease. Obstructive jaundice is a specific type of jaundice, where symptoms develop due to a narrowed or blocked bile duct or pancreatic duct, preventing the normal drainage of bile from the bloodstream into the intestines. All patients enrolled in this study were diagnosed as having inoperable malignant obstructive jaundice based on clinical symptoms jaundice, darkcolored urine, and pale stool, laboratory examinations elevated bilirubin levels, alkaline phosphatase levels, and gamma glutamyl transferase levels, and imaging examinations including transabdominal ultrasound, computed tomography ct scan of. As a reminder, jaundice, or icterus refers to the yellowish discoloration of the skin, sclerae, and mucous membranes caused by retention of bilirubin and. Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree. For more than 20 years, percutaneous transhepatic biliary. Jaundice disease with causes, treatment and nursing intervention. Presentation of jaundice pathophysiology of jaundice. Investigation and management of obstructive jaundice surgery. Major causes of obstructive jaundice are choledocholithiasis, pancreatic ca cholangiocarcinoma, periampullary ca aim.
Unrelieved obstruction causes everdeepening jaundice. Also called mechanical, cholestatic jaundice or surgical jaundice. Extrahepatic obstruction may be caused by bileduct plugging from gallstones, an inflammatory process, tumor or pressure from an enlarged gland intrahepatic obstruction may result from pressure on channels from inflamed liver tissue or exudates pathophysiology hemolytic jaundice. Main causes of obstructive jaundice bile duct in the lumen of the common bile duct gallstones, parasites in the wall of the duct choledochal cyst, sclerosing cholangigis, cholangiocarcinoma pressing in on the bile duct mirrizi, pancreatitis, pancreatic cancer, malignant nodes ampulla periampullary carcinoma tumor invading the ampulla. The yellow coloring comes from bilirubin, a byproduct of old red blood cells. Obstructive jaundice an overview sciencedirect topics. The diagnosis of obstructive jaundice remains difficult yet vital, since operative. Definition failure of normal amount of bile to reach intestine due to mechanical obstruction of the extra hepatic biliary tree or within the porta hepatis 3. This unconjugated bilirubin isnt watersoluble so cant be excreted in the urine.
If bilirubin levels in babies are very high for too long. Obstructive jaundice management linkedin slideshare. Definition jaundice is a symptom or syndrome characterized by increased bilirubin concentration in blood. It is now well established that many of these substances may effect liver function in a very selective fashion, resulting in a pattern of laboratory findings similar to those usually associated with surgical lesions of the biliary tree. Obstructive jaundice is a condition in which there is a blockage of the flow of bile out of the liver. The detection and differential diagnosis of jaundice are important in clinical assessment. Obstructive jaundice and severe pancreatitis due to the foramen of winslow hernia with multiple anomalies. Management of patients with malignant obstructive jaundice.
Hepatopancreatoduodenectomy for multifocal cholangiocarcinoma in the setting of biliary papillomatosis. Dysfunction in any of these phases may lead to jaundice. What is the pathophysiology of jaundice in biliary. No patient had underlying cirrhosis or hepatocellular carcinoma. Extrahepatic portal venous obstruction and obstructive.
Investigation and management of obstructive jaundice. Pdf management of obstructive jaundice in pregnancy. Indicated in severe jaundice or when there are signs of severe sepsis. Most times, jaundice comes as a symptom of an underlying disease. Posthepatic, or obstructive jaundice, happens when bilirubin cant be drained properly into the bile ducts or digestive tract because of a blockage. Obstructive jaundice caused by biliary tuberculosis. Haemostasis impairment in patients with obstructive jaundice. Jaundice disease with causes, treatment and nursing. Surgical exploration in obstructive jaundice of infancy.
Prehepatic phase the human body produces about 4 mg. Obstructive jaundice does not affect the pharmacokinetics of propofol administered by a single intravenous bolus. Obstructive jaundice often produces pruritus, pale stools, and dark colored urine. Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. This results in redirection of excess bile and its byproducts into the blood, and bile excretion from the body is incomplete. Cholestasis may occur within the liver in the hepatic ductules. Management of obsructive jaundice by mohd taofiq authorstream presentation. Management of obsructive jaundice by mohd taofiq authorstream. The treatment of jaundice in adults and elderly subjects is amongst the themes selected for elaborating the crps since jaundice is a medical sign frequently seen in four clinical scenarios involving distinctive diagnostic and therapeutic interventions which can be performed in different health care settings. You may also want to read about gallstones and jaundice for more information aetiology of.
Risk factors hemolytic jaundice transfusion reaction hemolytic anemia severe burns autoimmune hemolytic anemia hepatocellualr jaundice hepatitis yellow fever alcoholism obstructive jaundice extrahepatic obstruction may be. Clinical and regulatory protocol for the treatment of jaundice in. Clinical and regulatory protocol for the treatment of jaundice in adults and elderly subjects. Dr tan ek khoon, associate consultant, department of hepatopancreatobiliary and transplant surgery, singapore general hospital sgh, a member of the singhealth group explains the signs and symptoms as well as treatment options for obstructive jaundice. Bilirubin is a yellow compound that is produced from the breakdown of red blood cells in the body. Jaundice in babies occurs in over half in the first week following birth and does not pose a serious threat in most. Keywords obstructive jaundice, choledocholithiasis. Symptoms, causes, diagnosis, management and prevention jaundice is a term used to describe the yellowing of the skin and the whites of the eyes. Understanding the pathophysiology of haemostatic changes in patients with cholestasis, and, more generally, liver disease, is the hallmark of accurate diagnosis and treatment. Clinical spectrum of presentation of obstructive jaundice in. Management of obstructive jaundice in pregnancy, secondary to choledolithiasis with cholelithiasis. Obstructive jaundice definition of obstructive jaundice. Endoscopy and gastrointestinal specialised personnel is the cornerstone in management.
Pathophysiological consequences of obstructive jaundice and. This results in redirection of excess bile and its byproducts into the blood, and bile excretion from the body is. The first step in management of obstructive jaundice is based on the acuity of the disease and clinical status of the patient. Distinguishing surgical jaundice from medical jaundice is just the first step in the diagnosis and treatment. Ppt obstructive jaundice powerpoint presentation free. Management of these patients can be a major diagnostic and therapeutic. The treatment of jaundice in adults and elderly subjects is amongst the themes selected for elaborating the crps since jaundice is a medical sign frequently seen in four clinical scenarios involving distinctive diagnostic and therapeutic interventions which. Obstructive jaundice and pancreatic disease the bmj. Biliary drainage in the management of obstructive jaundice therefore represents one of the most important issues in the palliative treatment of these patients. Obstructive jaundice definition of obstructive jaundice by. Study the various causes and sites of obstruction of the biliary tree. Signs of obstructive jaundice watch out for yellowing of the skin and the whites of the eyes, which may be followed by itching of the skin.
Obstructive jaundice whipple s operation anesthetic management munisha agarwal professor deptt. Intestinal bacteria convert some of the extra bilirubin into urobilinogen, some of which is reabsorbed and is excreted. The disruption in the metabolism of bilirubin can occur at various stages. Jaundice is not usually apparent until serum bilirubin is over 35. Pdf on jul 18, 2018, ademola adeyeye and others published management of obstructive jaundice. The biliruben contained in bile has a yellow color, causing the persons skin, eyes and mucous membranes to turn yellow as well. Nonsurgical management of extrahepatic obstructive jaundice. It is classified as hemolytic, hepatocellular, or obstructive. Obstructive jaundice article about obstructive jaundice.
Prehepatic phase the human body produces about 4 mg per kg of bilirubin per day from the. If obstructive jaundice is left untreated, there is a high risk of infection when bilirubin overflows into the bloodstream. See classification and causes of jaundice or asymptomatic hyperbilirubinemia. Clinical spectrum of presentation of obstructive jaundice.
Patients of any age or sex admitted with complaints of jaundice, clinically and biochemically diagnosed to have obstructive jaundice were included in the study. Dec 23, 2015 jaundice is the yellow discolouration caused by accumulation of bilirubin in tissue. To discover the causative parameters of obstructivesurgical jaundice and the results of management in a local context setting. Thirteen patients nine males, aged 1250 years with ehpvo and obstructive jaundice were evaluated. Clinical and regulatory protocol for the treatment of.
Obstructive jaundice is commonly caused by gallstones large duct obstruction or a cancer of the head of the pancreas, or by disease processes that occlude the small bile ducts within the liver, such as hepatitis and cirrhosis small duct obstruction. Percutaneously placed biliary stents in the management of malignant biliary obstruction. A patient presenting with obstructive jaundice will need medical investigation to determine the cause of the obstruction and the treatment required. Oct 15, 2012 management comprises establishing the diagnosis, excluding pancreatic cancer, and supporting pancreatic exocrine and endocrine function. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. Obstructive jaundice and perioperative management sciencedirect. Obstructive jaundice algorithm an interdisciplinary approach for the management of bile duct obstruction. Abdominal pain along with fevers and jaundice is suggestive of obstruction with an associated infection known as cholangitis. Jaundice is a yellow color of the skin, mucus membranes, or eyes. Patients with hemodynamic instability, coagulopathy, andor renal dysfunction need to be quickly resuscitated prior to managing the specific etiology of. Obstructive jaundice or the presence of a pancreatic mass or both are the most common signs at acute clinical presentation, and symptoms such as anorexia or pain that requires opioid analgesia are rare.
You may also want to read about gallstones and jaundice for more information. Once the bile is in the bloodstream, it is then transported around to the bodys various organs. Pdf surgical obstructive jaundice can be lifethreatening. The bilirubin is taken from your blood by the liver, and then its. A pubmed was searched for relevant articles published up to august 2016. Management perioperative management of obstructive jaundice. The causes of the jaundice are usually classified on based up the dysfunction of the normal metabolism or execration of bilirubin. Obstructive jaundice is a common problem in daily clinical practice. Pdf management of patients with obstructive jaundice. Nov 04, 2019 obstructive jaundice is the type of jaundice resulting from obstruction of bile flow to the duodenum from the biliary tract. Mar 03, 2016 take home obstructive jaundice is a huge spectrum of differentials.
Corticotrophin and steroids in the diagnosis and management of obstructive jaundice. Presentation of jaundice pathophysiology of jaundice pre hepatic o increased breakdown of red cells leads to increased serum bilirubin. Management of these patients can be a major diagnostic and therapeutic challenge. Obstructive jaundice is the type of jaundice resulting from obstruction of bile flow to the duodenum from the biliary tract. Symptoms, causes, diagnosis, management and prevention.