Obstructive jaundice

Question 1

What is the definition of obstructive jaundice

Answer 1

Jaundice as a result of th ebile duct blockage resulting in no bile flowing from the liver into the duodenum

Question 2

Explain the common causes of obstructive jaundice

Answer 2

Intraductal
- Choledocholithiasis
- Foreign bodies such as a blocked billiary stent
- Ascaris worms

Intramural
- Malignant strictures
- Benign strictures

Extraductal
- Peri-ampullary malignancies
- Pancreatic pseudocyst
- Malignant portal lymphadenopathy
- Benign portal lymphadenopathy

Question 3

What are the common complications of obstructive jaundice

Answer 3

Acute cholangitis
Pruiritis
Coagulopathy
Acute renal failure

Question 4

What is the approach to investigating a patient with obstructive jaundice

Answer 4

History
Clinical examination
Abdominal ultrasound - presence of dilated biliary tree
Biochemical tests - LFT (Total bilirubin higher than normal range and conjugated atleast 70% of total bilirubin diagnostic of obstructive jaundice, if less than 30% it is hepatocellular or medical jaundice), INR, U&E, FBC, CRP

Question 5

What are the indications for urgent billiary tree drainage

Answer 5

Moderate or severe acute cholangitis
Non-resolveing acute renal dysfunction
Pruiritis
Bleeding despite vitamin K therapy

Question 6

Explain the biliary drainage procedures

Answer 6

Endoscopically using an endoscopic retrograde cholangiopancreaticogram
Percutaneously using a percutaneous cholangiogram
Transhepatic cholecystostomy
Bilio-enteric anastomosis