Your SlideShare is downloading. ×
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Obstructive jaundice:A physician's trap!
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Obstructive jaundice:A physician's trap!

4,062

Published on

Obstructive jaundice is a dangerous form of disease. It is invariably treated medically leading to a delay in diagnosing the surgical cause. Prompt multipronged approach is therefore essential for …

Obstructive jaundice is a dangerous form of disease. It is invariably treated medically leading to a delay in diagnosing the surgical cause. Prompt multipronged approach is therefore essential for early diagnosis.

Published in: Health & Medicine
0 Comments
11 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
4,062
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
6
Comments
0
Likes
11
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Obstructive Jaundice Dr.Ketan Vagholkar MS,DNB,MRCS,FACS Professor of Surgery & Consultant General Surgeon
  • 2. Surgical Anatomy of Extrahepatic Biliary Tract
  • 3. Bilirubin Metabolism
    • Fragile RBC
    • Cell Membrane Rupture
    • Hb released
    • Phagocytosed by REcells(macrophages)
    • Heme +Globin
    • Free iron combines with ferritin+Straight chains of 4pyrole nuclei forms the substrate from which bile pigments are formed
    • Biliverdin
    • Bilirubin(released into plasma)
    • Bound to albumin and trasportedto the liver. Then absorbed thru the hepatic cell membrane
    • .During this processit is released from albumin but remains attached to one of the proteins Y and Z inside the hepatic cells.
    • Bilirubin is detached from these proteins as well and is conjugated.
    • 80%bilirubin glucoronide
    • 10%bilirubin sulphate
    • 10%other substances
    • Biirubin is then excreted by an active process into the bile cacaliculi
    • Small amount of conjugated bilirubin enters plasma
    • Rest enters the intestine
    • In intestine
    • Conjugated bilirubin
    • Urobilinogen (bacterial action)
    • Enters kidney urobilinogen-urobilin
    • Rest enters gut-stercobilinogen-stercobilin
  • 4. Types of jaundice
    • Hemolytic
    • Obstructive
    • Hepatocellular
  • 5. Differences between individual types
  • 6. Classification of Obstructive Jaundice
    • Complete obstruction
    • Intermittent obstruction
    • Chronic incomplete obstuction
    • Segmental obstruction
  • 7. Classification of Jaundice
    • Complete obstuction
    • Tumors
    • Ligation of cbd
    • Cholangiocarcinoma
    • Tumors
    • Intermittent obstuction
    • Stones
    • Periampullary tumors
    • Choledochal cyst
    • Parasites
    • Duodenal diverticula
  • 8. Classification of Jaundice
    • Chronic incomplete obstruction
    • Strictures of cbd
    • Stenosed biliary enteric anastomosis
    • Chronic pancreatitis
    • Cystic fibrosis
    • Segmental obstruction
    • Traumatic
    • Sclerosing cholangitis
    • Cholangiocarcinoma
    • Hepatodocholithiasis
  • 9. Etiology(common causes)
    • Calculi
    • Strictures
    • Periampullary carcinoma
    • Chronic pancreatitis
  • 10. Clinical features
    • Jaundice
    • Odp,treatment taken,blood transfusions,pruritus,high colored urine,claycolored stools,waxing and wanning,sudden decrease in jaundice,therapeutic interventions.
    • Weight loss/anorexia/vomiting/distention of abdomen
    • Previous operations
    • Attacks of pain-pancreatitis
  • 11. Physical Examination (general examination)
    • Level of consciousness
    • Signs of hepatocellular failure
    • Vital parameters
  • 12. Per abdomen
    • Lump in rhc
    • Courvoisier’s law
    • Hepatosplenomegaly
    • Ascites
    • Pr/proctoscopy
  • 13. Investigations hematology
    • CBC
    • LFT
    • VIRAL MARKERS
    • COAGULATION PROFILE
    • RENAL PROFILE
  • 14. Investigations radiology
    • USG
    • ERCP
    • PTC
    • MRCP
  • 15. PREPARATION
    • Nutritional
    • Coagulation deficiency
    • Prevention of hepatorenal syndrome
    • Bowel preparation
  • 16. Therapeutic options
    • Benign causes
    • Stone disease
    • Strictures
    • Malignant cause
    • Periampullary growths
  • 17. Thank you

×