Investigation and management of obstructive jaundice c D briggs M peterson Abstract obstructive jaundice is a medical emergency. local guidelines should be in place and widely publicized to facilitate timely investigation and management and avoid complications. Management must involve The causes of obstructive jaundice are varied, and timely, accurate methods of investigation are essential to avoid the development of complications. Imaging, invasive or non-invasive, should be carefully selected depending on the suspected underlying pathology in order to determine the degree and l
Obstructive jaundice is a medical emergency. Local guidelines should be in place and widely publicized to facilitate timely investigation and management and avoid complications Ultrasound is the first line investigation for the assessment of jaundice. It is a quick and cheap test and effective in diagnosing biliary dilatation in the hands of an experienced operator. It can also help characterize lesions and determine the level of obstruction
Investigation of obstructive jaundice. Investigation will differentiate hepatocellular and obstructive jaundice in 90% cases. Blood results. Conjugated bilirubin >35 mmol/l; Increase in ALP / GGT >> AST / ALT; Albumin may be reduced; Prolonged PTT; Urinalysis finding Investigation of jaundice is heavily reliant on radiology, from the simplest of investigations (the ultrasound) through to much more complicated MRI-based test and intervention. It is important to determine whether jaundice is pre-hepatic, intra-hepatic or post-hepatic. Many of the tests that are performed by radiology are focused on assessment of. Secondly, painless obstructive jaundice is an indication for urgent investigation and rightly the next step is an ultrasound scan. To bypass the long routine wait for this, the GP phoned a local consultant gastroenterologist. What apparently happene 1. INVESTIGATIONS OF JAUNDICE. 2. AIMS• DETECT HEPATIC ABNORMALITY• ASSESS SEVERITY OF DAMAGE• DETECT PATTERN OF ABNORMALITY; HEPATIC OBSTRUCTIVE / CHOLESTATIC• SPECIFIC CAUSE• COMPLICATIONS. 3. LIVER FUNCTION TESTS• Tests for Manufacture & excretion of bile• Serum enzyme assays• Tests for metabolic functions• Immunological Tests• USS• Liver Biopsy Obstructive jaundice is a condition in which there is blockage of the flow of bile out of the liver. 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
Investigation of the cause of obstructive jaundice usually involves a myriad of blood tests and x rays. The recent development refinement and availability of new techniques--ultrasonography, computed tomographic scans (CT), and endoscopic retrograde cholangiopancreatography (ERCP), have significantly improved the diagnostic accuracy of establishing the cause of obstructive jaundice Role of Imaging in investigation of Obstructive jaundice 27. The principal role of imaging in the jaundiced patient is the identification and detailed assessment of major bile duct obstruction The causes of obstructive jaundice are varied, and timely, accurate methods of investigation are essential to avoid the development of complications. Imaging, invasive or non-invasive, should be carefully selected depending on the suspected underlying pathology in order to determine the degree and level of obstruction along with tissue acquisition and staging where relevant. Several imaging. AST and ALT are not usually raised in obstructive jaundice unless complicated by cholangitis. Mixed picture. Occasionally LFTs may indicate both cholestasis and hepatocyte damage, and this is usually due to cholangitis associated with stones in the common bile duct. Albumin. Low serum albumin suggests chronic liver disease
Jaundice is a clinical sign that reflects accumulation of bilirubin in blood. It can result from increased bilirubin production, inability of the liver to conjugate bilirubin or failure to excrete bilirubin into the biliary tree. Appropriate investigation of jaundice starts with a history of associated symptoms, and risk factors for liver disease Title: doi:10.1016/j.mpsur.2007.01.005 Created Date: 3/2/2007 1:38:16 A
1. J R Coll Surg Edinb. 1987 Apr;32(2):84-7. The investigation of obstructive jaundice: experience with 56 cases. Absoud EM. PMID: 3585853 [PubMed - indexed for MEDLINE Abstract Obstructive jaundice is a medical emergency. Local guidelines should be in place and widely publicized to facilitate timely investigation and management and avoid complications. Management must involve a multidisciplinary team that can offer a full range of investigative techniques (cross-sectional imaging, percutaneous procedures, endoscopic retrograde cholangiopancreatography) 1. CONCERNEDObstructive jaundiceINVESTIGATIONS 2. definition Biliary obstruction refers to the blockage of anyduct that carries bile from the liver to thegallbladder o
Biochemical investigation showed a bilirubin concentration of 151μmol/l, indicating obstructive jaundice[6]. Ultrasonography[9] showed dilatation of the biliary tree down to the common hepatic duct with a stone obstructing the neck of the gall bladder, which was dilated Recently, the etiological spectrum of unselected patients with jaundice has been reported.12 Among patients with cholestatic jaundice, abdominal ultrasound remains the primary investigation in order to distinguish extrahepatic biliary obstruction from intrahepatic disease 1. What is the clinical type of jaundice? Obstructive jaundice. 2. What other laboratory investigation you will perform in this case? CBC Stool OBT Urobilinogen in urine increased starcobilinogen in stool Decreased PT INR S. Creatinine S. Electrolytes 3
Differential Diagnosis of Jaundice The jaundice is defined as the discoloration of skin, eye, and sclera with serum bilirubin >3mg/dL. Based on the etiology, jaundice can be classified into pre-hepatic (hemolytic jaundice), hepatocellular jaundice and post-hepatic (obstructive) jaundice 1) ERCP, 2) X-ray abdomen, 3) USG, 4) CT scan, 5) NUL Viral Hepatitis, toxic hepatitis, cirrhosis. of liver, Malignancy. Cholestatic drugs eg. Chlorpromazin, methyl testosterone, PAS. Post hepatic or obstructive jaundice. Blocked excretion of bile form the liver eg. Stone in the CBD or on CA pancreas etc. fff Aetiology Hepatopancreatobiliary II,Presentation of jaundice. Stones in common bile duct Malignancy Drug induced cholestasis Acute viral hepatitis. History Dyspepsia biliary colic Nil Drug history present Transfusions. and last 6 12 months injections contacts, Pain Colic epigastric to back Epigastric to back None Discomfort in right. episodic none constant none upper quadrant none,Weight loss Slight. Radiological Investigation: USG • Findings will be 1. Presence of Dilated IHBR is s/o of Obstructive Jaundice. 2. CBD Diameter (Normal is 7 -8 mm) if it is more than 8 mm suggestive of dilatation. 3. Gall Stone and CBD Stone Can be identified. 4. Mass in CBD can be detected if it is >2 cm. 5. Pancreatic Head Malignancy detected if >2 cm. 6
Background & Objective: Patients with obstructive jaundice constitute significant proportion of patients presenting with jaundice at our hospital. In present study it is proposed to investigate primarily the diagnostic accuracy of MRCP and ERCP in defining etiology, level of obstruction in obstructive jaundice The need for radiological imaging in obstructive jaundice are: 5 (1) to confirm the presence of biliary system obstruction (i.e., to discriminate surgical versus medical jaundice) , (2) to determine the level of the obstruction, (3) to identify the specific cause of the obstruction, and (4) to provide complementary information relating to the underlying diagnosis (e.g., staging information in. Liver Biochemistry . In hepatitis, the serum ASTor ALT tends to be high early in the disease with only a small rise in the serum ALP.. Conversely, in . extrahepatic obstruction . the ALP is high with smaller rise in aminotransferases. These findings . cannot. be relied on alone to make a diagnosis in an individual case
Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Jaundice in adults is typically a sign indicating the presence of underlying diseases involving abnormal heme metabolism, liver dysfunction, or biliary-tract obstruction. The prevalence of jaundice in adults is rare, while jaundice in babies is common, with. Accuracy of abdominal ultrasonography and the role of a second investigation in surgical obstructive jaundice. Dwivedi M(1), Acharya SK, Nundy S, Tandon BN. Author information: (1)Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi Jaundice (icterus) is the result of accumulation of bilirubin in the bloodstream and subsequent deposition in the skin, sclera, and mucous membranes. The normal range for total bilirubin is 0.2 to 1.2 mg/dL. Jaundice may not be clinically evident until serum levels >3 mg/dL. Jaundice might result..
Jaundice syndrome in general and obstructive jaundice in particular, have multiple . causes etiopathogenic. This paper proposes radio-imaging evaluation of patients with . obstructive jaundice caused by biliary obstruction in order to study the morphology and . analysis of the effects of biliary obstruction on liver parenchyma and biliary tract. Investigation of choice in obstructive jaundice is: 1) Ultrasoun For patients with jaundice who do not have predisposing conditions, ultrasound is the preferred initial modality of investigation. Ultrasound in the diagnosis of obstructive jaundice Obstructive processes cause dilatation of the intrahepatic or extrahepatic biliary tree, which can usually be detected using ultrasound
a malignant obstruction had abdominal pain versus 71% of patients with a benign obstruction(P.05).Attheendoffollow-up,only5%(8patients)withamalignant obstruction were alive versus 78% with a benign obstruction. CONCLUSIONS: Obstructive jaundice was the cause of the severe jaundice of one third of patients Obstructive jaundice: concerned investigations 1. CONCERNED Obstructive jaundice INVESTIGATIONS 2. definition Biliary obstruction refers to the blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine Jaundice in adults can be an indicator of significant underlying disease. It is caused by elevated serum bilirubin levels obstruction and hepatocellular damage, as well as pan Jaundice is the commonest presentation of patients with liver and biliary disease. The cause can be established in most cases by simple non-invasive tests, but many patients will require referral to a specialist for management. Patients with high concentrations of bilirubin (>100 μmol/l) or with evidence of sepsis or cholangitis are at high risk of developing complications and should be.
Obstructive jaundice which can be either due to intra-hepatic cholestasis or extra-hepatic biliary obstruction is amenable to surgical treatment. Hence, it is also called surgical jaundice. It is difficult to diagnose the type and cause of obstruction on clinical grounds alone. But there are certain clinical criterion's associated with it Jaundice, a physical exam finding of yellowish discoloration of the skin, conjunctiva, and/or mucous membranes, is a consequence of obstruction leading to bile stasis and buildup of conjugated bilirubin in the blood. Normal total serum bilirubin values are 0.2 to 1.2 mg/dL. Jaundice is evident clinically at the level of 3 mg/dl
Endoscopic retrograde cholangiopancreatography is also used for the treatment of obstructive jaundice, and gallbladder or a pancreatic tumor. MRCP helps in visualizing the bile and the pancreatic ducts. The use of MRCP in diagnosing bile duct obstruction may avoid the use of unnecessary invasive procedures like ERCP The causes of obstructive jaundice are varied, and timely, accurate methods of investigation are essential to avoid the development of complications. Imaging, invasive or non-invasive, should be carefully selected depending on the suspected underlying pathology in order to determine the degree and level of obstruction along with tissue. Uterine cancer presenting as obstructive jaundice. Abstract: Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer. After detailed diagnostic investigation, the cause of the jaundice was attributed. 1-emedicine.medescape.com 2- BMJ application . 3- healthgarde.com 4-slideshare.com LAB INVESTIGATION Resources Clinical approach for obstructive jaundice by : dr.yazan alqaisi Introduction Bilirubin metabolism clinical approach Personal history : (name , age , sex , occupation
The chemical composition of the unique lipoprotein, LP-X, was similar to that of an abnormal lipoprotein, OLP, isolated by Russ et al. (29) and by Switzer (30). In obstructive jaundice plasma, the combined LP-X and LP-B accounted for 98% and the LP-A for only 2% of the total protein content of the LDL fraction Jaundice happens when too much bilirubin builds up in your blood. This makes your skin and the whites of your eyes look strikingly yellowish. Bilirubin is a yellowish pigment created as hemoglobin. Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential
Inclusion criteria: • Age - More than 12 years. • Patients proved to have obstructive jaundice by any investigative modality during the study period from April 2004 to March 2005. Exclusion criteria: • Age less than 12 years, • Medical jaundice, • Cases of obstructive jaundice who are unfit for interventional treatment The abnormal lipoproteins of the density range 1.019-1.063g/cm3 occurring in the plasma of patients with obstructive jaundice were studied. Subfractionation of this density class by combined sodium phosphotungstate precipitation, ultracentrifugation, and column chromatography on hydroxyapatite and agarose gel yielded essentially three fractions: (1) lipoprotein-X, (2) A triglyceride-rich. The investigation report was as follows-Hb-5gm% ,slightly increased SGPT level is suggestive of post hepatic or obstructive jaundice. Furthermore, the diagnosis is supported by the presence of bilirubin (since it is conjugated) and the absence of urobilinogen (Since there is an obstruction to the outflow of bile) in the urine.. Obstructive jaundice: a clinical review for the UK . armed forces. S K Roy, A Lambert. Abstract. Obstructive jaundice is a clinical condition that indicates the possibility of a significant underlying disease process. This clinical review considers the pathophysiology, investigation and management of patients with obstructive jaundice and.
Alone, jaundice has no adverse effects (except in the neonate). It is the task of the Emergency Physician to evaluate the cause of jaundice by arranging appropriate initial investigations, and making a decision regarding the need for admission and further investigation and management Abstract Background Obstructive jaundice results in failure of the intestinal barrier with consequent systemic endotoxemia associated with septic complications. We have recently shown that gut bar.. Key points. If significant jaundice is clinically suspected, a serum bilirubin level should be performed as visual estimation of jaundice is unreliable. The majority of jaundice in well infants is physiological, and does not require investigation and management. Features suggestive of pathological jaundice include: onset <24 hours old, unwell. Background: Cholelithiasis is the commonest cause of obstructive jaundice and for the investigation of cholelithiasis and obstructive jaundice ultrasound is a gold standard modality. Obstructive jaundice is generally due to biliary obstruction, which is a blockage of the common bile duct or any duct that carries bile from the liver to the.
Jaundice occurs in approximately 60% of newborns but only a few will require investigation and treatment. Jaundice may not be visible in the neonate's skin until the bilirubin concentration exceeds 70 - 100 micromol/L. Major risk factors for severe hyperbilirubinaemia include jaundice within the first 24 hours and blood group incompatibility Jaundice and its Investigation Andrew M Smith Jan 2011 Case 3 You are asked to make a home visit to see a 53 yr old man with severe abdominal pain Obstructive Jaundice. 2 Followers. Recent papers in Obstructive Jaundice. Papers; People; Management of fibrosing pancreatitis in children presenting with obstructive jaundice. Background—Children with fibrosing pancreatitis are conventionally treated surgically to relieve common bile duct (CBD) obstruction caused by pancreatic compression. Physiological jaundice can progress to pathological jaundice if the baby is premature or there is increased red cell breakdown e.g. Extensive bruising or cephalohaematoma following instrumental delivery. Pathological jaundice. Jaundice which requires treatment or further investigation Non-Obstructive Jaundice In Surgical Patients. This micro skills course will cover the identification and investigation of jaundice. It will describe the underlying causes and the implications for surgery. $ 19.99. Enrol Now Request more information. Delivery Mode. Online - Self Paced
View Obstructive jaundice_finalised.ppt from CT 012 at Asia Pacific University of Technology and Innovation. BY DR. Allah Obhayo Unar Department of surgery IMS, MSU Must know Must do Must know - Ho Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57 consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of more than transient duration. Eight presented as jaundice complicating knownpancreatitis and three as jaundice ofunknowncause
The red cells of patients with obstructive jaundice are flat and osmotically resistant and have an increased cholesterol:phospholipid ratio. When transfused into normal subjects these target cells rapidly lose their osmotic resistance. Similarly, normal cells acquire osmotic resistance in the circulation of patients with 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 Conclusion: USG is a cost-effective, noninvasive, and nonionizing easily available preliminary investigation in the evaluation of obstructive jaundice but MRCP scores over USG for evaluation of small hepatic metastasis in the presence of pancreaticobiliary malignancies that may be missed with USG Obstructive jaundice: which can occur as a result of an obstruction in the bile duct preventing bilirubin from leaving the liver. The bile duct consists of a system of tubes which carry bile from the liver to the gallbladder and the small intestine. Examples can be a cyst, gallstones in the ducts of the biliary system, scar tissue due to a.
