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.