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. Hepatitis a is usually a selflimited illness that presents with acute onset of jaundice. Prehepatic and intrahepatic causes are known as medical jaundice, while posthepatic or obstructive jaundice is considered surgical jaundice. Also called mechanical, cholestatic jaundice or surgical jaundice as a reminder, jaundice, or icterus refers to the yellowish discoloration of the skin, sclerae, and mucous membranes caused by retention of bilirubin andor its conjugates. Extrahepatic obstructive jaundice is an indication for surgical treatment, except perhaps in cases of sclerosing cholangitis. To determine the etiological spectrum of obstructive jaundice in a tertiary care hospital. Jaundice in the newborns jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. Ascaris lumbricoides is one of the most prevalent parasitic infections, especially in developing countries. Sep 12, 2012 based on pathophysiology jaundice can be obstructive jaundice prehepatic jaundice hepatocellular jaundice 5. Obstructive jaundice is a particular type of jaundice when the essential flow of bile to the intestines was blocked.
Among the different types of malignancy causing obstructive jaundice, pancreatic cancer and cholangiocarcinoma were the most common, followed by the other malignancies category table 1. A case study on choledocholithiasis human digestive. Presentation of jaundice pathophysiology of jaundice pre hepatic o increased breakdown of red cells leads to increased serum bilirubin. Suspect biliary obstruction due to cancer in elderly patients with painless jaundice, weight loss, an abdominal mass, and minimal pruritus. Ireland academic rcsi department of surgery, beaumont hospital 3rd med p. For the sake of simplicity, the primary focus of this article is mechanical causes of biliary obstruction, further separating them into intrahepatic and extrahepatic causes. Key words obstructive jaundice hepatocellular carcinoma. Pathophysiology caused by obstructive jaundice involving coagulopathies, infection, renal dysfunction, and other adverse events should be fully assessed and reversed preoperatively. Obstructive jaundice causes, symptoms, pathophysiology, diagnosis and treatment what is obstructive jaundice. Intestinal bacteria convert some of the extra bilirubin into urobilinogen, some of which is reabsorbed and is excreted.
Obstructive jaundice often produces pruritus, pale stools, and dark colored urine. American college of radiology acr appropriateness criteria. A case study on choledocholithiasis free download as word doc. Levels above 2 mgdl result in detectable jaundice, first in the sclerae, next under the tongue and along the tympanic membranes, and finally in the skin. Evaluation of jaundice in adults american academy of. Pathophysiology choledocholithiasis free download as word doc. In posthepatic jaundice or obstructive jaundice, there is an impediment to the flow of bile due to a partial or complete obstruction of the extrahepatic biliary passage between the liver.
Neonatal hyperbilirubinaemia is usually physiologic, unconjugated, and selflimited. The clinical setting of cholestasis or failure of biliary flow may be due to biliary obstruction by mechanical means or by metabolic factors in the hepatic cells. Obstructive jaundice due to a blood clot after ercp. Guidelines for elaborating the clinical and regulatory protocols. Patients with malignant versus benign obstructive jaundice were similar in age table 3. Rle case study obstructive jaundice free download as word doc.
Normally, serum bilirubin should never exceed 1 to 1. Jaundice caused by obstruction of the drainage through the bile ducts, as may occur with gallstones. What is the pathophysiology of jaundice in biliary. Oct 16, 2019 the clinical setting of cholestasis or failure of biliary flow may be due to biliary obstruction by mechanical means or by metabolic factors in the hepatic cells. Man ordinarily tolerates mechanical obstruction of the common bile duct fairly well. Posthepatic postliver jaundice, also called obstructive jaundice, is caused by an interruption to the drainage of bile containing conjugated bilirubin in the biliary system. Bilirubin, a component of bile, is yellow, which gives the characteristic yellow. Death from obstructive jaundice in the first few weeks of its course is quite rare and is only occasionally observed. Slow onset of painless jaundice with central abdominal ache, loss of appetite and loss of weight suggests carcinoma. Congenital obliteration of the bile ducts is a rare type. Too much bilirubin absorbed into the blood may cause obstructive jaundice. Rle case study obstructive jaundice gallbladder bile scribd. Stones that are too large to pass through the ampulla of vater remain in the distal common bile duct, causing obstructive jaundice that may lead to.
Stones that are too large to pass through the ampulla of vater remain in the distal common bile duct, causing obstructive jaundice that may lead to pancreatitis, hepatitis, or cholangitis. Jaundice is the most common cause of readmission after discharge from birth hospitalization. Investigation and management of obstructive jaundice. Obstructive jaundice free download as powerpoint presentation. Smith several authors14 have found that there is little evidence for the existance of a specific hepatorenal syndrome, and yet there is evidence in animals5 that jaundice makes the kidney more sensitive to anoxic damage. Investigation and management of obstructive jaundice c d briggs m peterson abstract obstructive jaundice is a medical emergency. Bile duct stones choledocholithiasis nursing care and. Obstructive jaundice secondary to choledocholithiasis scribd. Jun 01, 2015 the best i could come up with on obstructive jaundice slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The most common causes are gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas. Clinical and regulatory protocol for the treatment of jaundice in adults and elderly subjects.
Download as doc, pdf, txt or read online from scribd. The causes of obstructive jaundice included gall stones in 20 40% patients, mass head of pancreas in 16 32%, and biliary strictures in 4 8% cases while hepatic abscesses, pseudopancreatic. Obstructive jaundice and perioperative management sciencedirect. The causes of the obstructive jaundice are shown in table 1. Pathophysiology is not well understood, but it is thought that substances in breast milk, such as betaglucuronidases and nonesterified fatty acids. Of nursing a case study about obstructive jaundice secondary to. Understanding the pathophysiology of haemostatic changes in patients with cholestasis, and, more generally, liver disease, is the hallmark of accurate diagnosis and treatment. College of nursing a case study about obstructive jaundice secondary to. Haemostasis impairment in patients with obstructive jaundice. Obstructive jaundice an overview sciencedirect topics. Jaundice is the yellowing of the skin and sclera due to abnormally elevated levels of bilirubin in the blood. Obstructive jaundice induced by biliary ascariasis bmj. It can be characterized into three different categories including prehepatic.
Obstructive jaundice pancreatic cancer liver scribd. Jo jh, cho cm, jun jh, et al, for the eus study group of the korean society of gastrointestinal endoscopy. Systemic effects immunity increased bacterial translocation from the gut in the setting of bile duct obstruction wound healing delayed wound healing and a high incidence of wound dehiscence and incisional hernia have been observed in patients undergoing surgery to relieve obstructive jaundice 11. A systematic approach to patients with jaundice article in seminars in interventional radiology 3304. Obstructive jaundice causes, symptoms, pathophysiology.
Congenital anomalies of the biliary tract that manifest as cystic dilatation of the extra hepatic and intra hepatic bile ducts females are most commonly affected etiology. Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. Anatomy and physiology liver jaundice bile gallbladder scribd. Schematic diagram concept map for bile duct stones via. Schematic diagram obstructive jaundice free download as word doc. The causes of jaundice and asymptomatic hyperbilirubinemia, detailed discussions of the specific testing used, and the evaluation of patients with other liver test abnormalities are discussed elsewhere. Extrahepatic obstruction may be caused by bileduct plugging from gallstones, an inflammatory process, tumor or pressure from an enlarged gland. This breakage of the gut barrier in obstructive jaundice is multifactorial, involving disruption.
Download as pptx, pdf, txt or read online from scribd. Obstructive jaundice may be caused by a gallstone lodged in the common bile duct, carcinoma of the pancreas, bile duct or ampulla and, rarely, benign biliary strictures. Obstructive jaundice whipple s operation anesthetic management munisha agarwal professor deptt. The causes of jaundice and asymptomatic hyperbilirubinemia, detailed discussions of the specific testing used, and the evaluation of patients with other liver. Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Astone or wormin the common bile duct, extrinsic or intrinsic carcinoma blocking the bile duct, or fibrous tissue compressing or strangling the main bile duct or some of its tributaries will all lead to jaundice of the obstructive type. Etiology and epidemiology of obstructive jaundice in. Physiologic jaundice occurs 3 to 5 days after birth and is an increase in unconjugated bilirubin levels that do not exceed 5 mg100 dl day. Obstructive jaundice and perioperative management request pdf.
Chapter 80 obstructive jaundice francis aba uba mohammed a. The depressed cardiovascular effects of obstructive jaundice are worth noticing because it has complicated mechanisms and needs to be further explored. This may be evidenced by darkcolored urine seen in patients with obstructive jaundice or jaundice due to. Obstructive jaundice jaundice, also known as icterus, attributive adjective. Jaundice is a manifestation of elevated serum bilirubin, and can have many causes, some of which can be lifethreatening. A systematic approach to patients with jaundice request pdf. B srinivas dept of surgery mnr medical college obstructive jaundice definition. Systemic effects immunity increased bacterial translocation from the gut in the setting of bile duct obstruction wound healing delayed wound healing and a high incidence of wound dehiscence and incisional hernia have been observed in patients undergoing surgery to relieve obstructive jaundice. In all babies with prolonged jaundice, blood should be taken for total and conjugated bilirubin level. Symptoms of obstructive jaundice include the typical yellowing of jaundice as well as dark urine, pale feces, and itching.
Prehepatic phase the human body produces about 4 mg per kg of bilirubin per day from the. A support for the health care network professional, preferably linked to the university, with participation of primary care practitioners and the rs team. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify. The modern way of life and nourishment causes the increased incidence of cholesterol gallstones3, and the characteristic of the nourishment in the continental croatia is the food rich in fats. In prehepatic jaundice, there is excess productionof bilirubin that overtakes the ability of liver to conjugate the bilirubin and excrete into the gut. Oct 16, 2019 zhu y, wang s, zhao s, qi l, li z, bai y. Intrahepatic obstruction may result from pressure on channels from inflamed liver tissue or exudates.
Jaundice is a yellow discoloration of body tissues due to an excess of bilirubin, a pigment produced during the metabolism of heme. Onset of clinical jaundice is seen when serum bilirubin levels are 5 to 7 mg100 dl. Pathophysiology of obstructive jaundice springerlink. Presentation of jaundice pathophysiology of jaundice. Obstructivejaundice free download as powerpoint presentation. Less commonly, stones are formed in the intrahepatic biliary tree, termed primary hepatolithiasis, and may lead to choledocholithiasis. An algorithmic approach to the evaluation of jaundice in adults. Based on pathophysiology jaundice can be obstructive jaundice prehepatic jaundice hepatocellular jaundice 5. A patient presenting with obstructive jaundice will need medical investigation to determine the cause of the obstruction and the treatment required.
Jaundice is a symptom of an underlying condition that impairs the excretion of bilirubin from the body. Obstructive jaundice is the type of jaundice resulting from obstruction of bile flow to the duodenum from the biliary tract. Jaundice becomes visible when the bilirubin level is about 2 to 3 mgdl 34 to 51 micromoll. Pdf pathophysiology of increased intestinal permeability. This was recognised by whipple in 1935 who recommended an initial cholecystogastrostomy to relieve jaundice prior to a pancreatic resection. Ppt obstructive jaundice powerpoint presentation free. Gudelj graanin et al obstructive jaundice in continental croatia, coll. Etiological spectrum of obstructive jaundice in a tertiary. This results in redirection of excess bile and its byproducts into the blood, and bile excretion from the body is incomplete. This article highlights the diagnosis, complications and treatment. Clinical and regulatory protocol for the treatment of. Choledocholithiasis may produce symptoms of a classic gallbladder attack. This unconjugated bilirubin isnt watersoluble so cant be excreted in the urine. Jul 23, 2016 i am discussing about the various causes of obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose the various causes for.
Full text get a printable copy pdf file of the complete article 5. After a period varying from four to six months, however, patients suffering from occlusion of. Dysfunction in any of these phases may lead to jaundice. What is the pathophysiology of jaundice in biliary obstruction. Pathophysiology obstructive jaundice bile exocrine. Distinct from breastfeeding jaundice, breast milk jaundice develops in the second week of life, lasts longer than physiologic jaundice, and has no other identifiable cause. Obstructive jaundice is a condition in which there is a blockage of the flow of bile out of the liver. As the 120day lifespan of a red blood cell comes to an end or the cell becomes damaged, the. As patients obstructive jaundice have with high morbidity and mortality, earlydiagnosis of the cause of obstruction is very importantespecially in malignant cases, as resection is only possible at that stage. We describe a case of a man who presented as an emergency to the general surgeons complaining of abdominal pain, fever, jaundice. Its presence can lead to a multitude of presentations, one of the rarer ones being obstructive jaundice due to migration of the worm in to the biliary tree. This issue will help the emergency clinician narrow down the differential diagnosis to determine a cause and allow for swift disposition. Etiological spectrum of obstructive jaundice in a tertiary care hospital. Congenital weakness of the bile duct wall congenital obstruction of the bile ducts reo virus association is seen in 78% of patients 40% of anomalies are.
This topic will provide an overview of the diagnostic approach to adults with jaundice or asymptomatic hyperbilirubinemia. Pathophysiology obstructive jaundice free download as word doc. Pathophysiology choledocholithiasis bile gallbladder scribd. Jaundice usually occurs because of an underlying condition with the liver that means it. The key event in the pathophysiology of obstructive jaundice associated complications is endotoxemia of gut origin because of intestinal barrier failure. Obstructive jaundice secondary to choledocholithiasis free download as. Anatomy and physiology liver jaundice free download as word doc. The patient who is to undergo surgical treatment of gallstones is often. Obstructive jaundice is a condition of raised bilirubin levels in the blood known as conjugated hyperbilirubinemia that occurs as a result of obstruction to flow of bile due to any cause and preventing bilirubin from reaching the gut. Most easily recognised in fairskinned individuals, difficult in darkly pigmented patients most easily seen in the sclera, under tongue yellowgreen in appearance in chronic, severe obstructive jaundice biliverdin. Obstructive jaundice secondary to choledocholithiasis free download as word doc. Main causes of obstructive jaundice bile duct in the lumen of the common bile duct gallstones, parasites. Pathophysiology of obstructive jaundice slideshare.
Jaundice is a condition that causes skin and the whites of the eyes to turn yellow. I am discussing about the various causes of obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose the various causes. This hyperbilirubinemia subsequently causes increased levels. If you continue browsing the site, you agree to the use of cookies on this website. Hamza introduction neonatal cholestasis is defined as prolonged elevation of serum levels of conjugated bilirubin beyond the first 14 days of life. Obstructive jaundice management pdf if i would open a discussion on the endresults of the surgical treatment of. Specific problems may result from obstructive jaundice complicating pancreatic disease, and this is reflected in a higher mortality when surgery is performed in the presence of jaundice. Failure of normal amount of bile to reach intestine due to mechanical obstruction of the extra hepatic biliary tree or within the porta hepatis. The attacks begin with acute abdominal pain in the right upper quadrant that may radiate to the back, between the shoulders, or to the front of the chest. The causes of jaundice in the first weeks of life can becategorised into hematologic, enzymaticmetabolic, infectiousand obstructive.