Obstructive jaundice

Also known as Post hepatic jaundice. Caused mainly due to interruption to drainage of bile in the biliary system.

Most common causes are gallstone in the common bile duct, and pancreatic cancer in the head of the pancreas. Even liver flukes may cause obstruction.

Clinical features:

Pale or clay coloured stools, tea coloured urine, sever pruritus, yellowish discolouration of skin and sclera.


Investigations:

Blood results

• Conjugated bilirubin >35 mmol/l
• Increase in ALP / GGT >> AST / ALT
• Albumin may be reduced
• Prolonged PTT

Ultrasound

• Normal CBD <8 mm diameter
• CBD diameter increase with age and after previous biliary surgery
• For obstructive jaundice ultrasound has a sensitivity 70 - 95% and specificity 80 - 100%
• In future endoscopic ultrasound may become more widely available

Treatment:

ERCP (Endoscopic Retrograde Cholangio Pancreatography)
- complications:
bleeding, damage to the bowel, infection or pancreatitis

PTC (Percutaneous Transhepatic Cholangiography) and percutaneous biliary drainage

Resection
Resection is the surgical removal of a diseased or damaged part of the body. It normally involves major surgery

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