Brief overview of Obstructive Jaundice

1. BY
ANIEDU, UGOCHUKWU .I.
CR1
OBSTRUCTIVE JAUNDICE

2. Outline
 Introduction
 Pathophysiology
 Causes
 Clinical presentation
 Investigation
 Complications
 Treatment
 References

3. Introduction
 Obstructive jaundice is a condition in which there is blockage of
the flow of bile out of the liver to the intestine. This results in
redirection of excess bile and its by-products into the blood, and
bile excretion from the body is incomplete. Bile contains many
by-products, one of which is bilirubin, a pigment derived from
dead red blood cells. Bilirubin is yellow, and this gives the
characteristic yellow appearance of jaundice in the skin, eyes,
and mucous membranes.

4. Pathophysiology

5.  Bile is the exocrine secretion of the liver and is produced
continuously by hepatocytes. It contains cholesterol and
waste products, such as bilirubin and bile salts, which aid in
the digestion of fats. Half the bile produced runs directly from
the liver into the duodenum via a system of ducts, ultimately
draining into the common bile duct (CBD). The remaining
50% is stored in the gallbladder.
 In response to a meal, this bile is released from the
gallbladder via the cystic duct, which joins the hepatic ducts
from the liver to form the CBD. The CBD courses through the
head of the pancreas for approximately 2 cm before passing
through the ampulla of Vater into the duodenum

6.  Biliary obstruction refers to the blockage of any duct that
carries bile from the liver to the gallbladder(intrahepatic) or
from the gallbladder to the small intestine(extrahepatic).
 This can occur at various levels within the biliary system.

8. Causes
 Calcular: Gall bladder stones passing through
cystic duct to obstruct the common bile duct.
 Malignancy:
- Cancer head of the Pancreas.
- Cholangiocarcinoma. E.g Klatskin tumor

10. Clinical Presentation
 Jaundice ( Yellowish sclera and skin )
 Itching
 Pain(RUQ)
 Fever
 Dark urine
 Pale stool.

12. Pale stool and dark urine

13. Investigation
 Laboratory:
-Total bilirubin and Direct bilirubin(Conjugated)
 Direct bilirubin more elevated than indirect.
- Liver Enzymes  elevated.
- Hepatitis Markers (A, B & C).
- Coagulation Profile : Increased PTT.

14.  Radiological:
-Ultrasound Abdomen  showing dilated
CBD + stones. > 7mm in diameter
- CT and MRI Abdomen  showing
pancreatic tumor and liver metastasis.
- ERCP (Endoscopic retrograde cholangio-
pancreatography)  diagnostic and
therapeutic.

17. Complications
 Cholangitis
 Coagulopathy
 Pancreatitis
 Liver cirrhosis
 Cholestasis with pulmonary stenosis

18. Treatment
Treatment options for obstructive jaundice depend on the exact
cause of the jaundice and on the severity of the disease.
 Antibiotic therapy (if indicated for infection)
 Endoscopic retrograde cholangiopancreatography (ERCP), an
imaging procedure that allows treatment of some bile duct
problems, including removal of gallstones that are causing
obstruction
 Intravenous fluids and pain medications

19.  Nutritional support (IV Vit K)
 Surgery or other procedures to repair anatomical defects or
create alternative pathways for the flow of bile
 Transplantation of the liver (if all other methods are
unsuccessful and all of the liver is damaged)
 Treatment for cancer, if present, which may include
chemotherapy, radiation therapy or surgery such as Whipple
procedure (pancreatoduodenectomy).

20. References
 http://emedicine.medscape.com/article/187001-
overview. Retrieved on 9th March, 2016
 http://www.healthgrades.com/right-care/digestive-
health/obstructive-jaundice--treatments. Retrieved on
the 10th March, 2016
 http://www.slideshare.net/hatemelgohary712/obtructiv
e-jaundice?from_action=save. Retrieved on 10th
March, 2016