obtructive jaundice dr hatem el gohary

OBSTRUCTIVE JAUNDICE

Dr Hatem EL Gohary

Lecturer of General Surgery

Definition of jaundice

Yellowish discoloration of sclera and skin due to high levels of bilirubin which is manifested above 2 mg/dl.

Physiology of Bilirubin

CausesCalcular: Gall bladder stones passing

through cystic duct to obstruct the common bile duct.

Malignant: - Cancer head of the Pancreas. - Cholangiocarcinoma.

Clinical Picture Jaundice (sclera – Palate) ItchingPain (Cholangitis) Fever (Cholangitis)Dark urine Pale stool.

Investigations

Laboratory: -Total bilirubin and Direct bilirubin(Conjugated) Direct bilirubin more elevated than indirect. - Liver Enzymes elevated. - Hepatitis Markers (A, B & C). - Coagulation Profile (Prothrombin time).

Radiological:-Ultrasound Abdomen showing dilated CBD + stones.- CT and MRI Abdomen showing pancreatic tumor and liver metastasis.- ERCP (Endoscopic retrograde cholangio- pancreatography) diagnostic and therapeutic.

Treatment General: IV fluids – Urine output chart –

Vitamin K –Broad spectrum Antibiotics.

Calcular:- Removal of CBD stones either by ERCP or By Surgical CBD Exploration + Cholecystectomy.

Malignant: Whipple’s Operation.