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Approach to Surgical Jaundice.pptx
- 1. Approach to Obstructive Jaundice Udit Mishra Surgery Resident
- 2. Outline • History • Examination • Investigations • Treatment
- 3. History • Is it jaundice or not • Obstructive vs Hemolytic jaundice • Causes that led to jaundice • Condition/status of the patient • Complications
- 4. Jaundice • Yellowish pigmentation of sclera or other mucus membrane due raised bilirubin level in blood (>2mg/dl) • Jaundice without any prodormal symptoms is usually Surgical jaundice
- 5. Causes • Intraluminal – Primary and secondary CBD stones – Flukes • Fasciola • Ascariasis • Clonorchis • Schistosomiasis – Tumor emboli
- 6. • Mural – Congenital • Congenital atresia • Choledochal cyst – Inflammatory • Sclerosing cholangitis – Neoplastic • Cholangiocarcinoma – Benign Stricture • Post traumatic • Post radiotherapy • Post inflammatory
- 7. • Extra luminal – Malignant : • Periampullary carcinoma • Carcinoma head of pancreas • Carcinoma gall bladder • Porta hepatis nodes – Carcinoma gall bladder – Carcinoma stomach – Colorectal malignancy – Benign : • Chronic Pancreatitis • Mirrizi syndrome
- 8. History continued • Age, sex, demography • Jaundice – onset, progression, duration • Urine color • Stool color • Abdominal pain • Pruritus • Anorexia, early satiety, Weight loss • High grade fever with chills and rigor • Change in bowel habit • Alcohol or drug intake • Previous biliary surgery • Systemic review
- 9. Physical examination • To know the – Status of the patient – Cause – Complications
- 10. • Vital status • Eyes • Scratch marks • Signs of liver cell failure : • Testicular atrophy • Gynecomastia • Vascular spiders • Dupuytren’s contracture • Parotid enlargement • Palmer erythema • Hepatomegaly • Palpable gall bladder
- 11. • Courvoiser’s law • Exceptions • Charcot’s Triad, Reynold’s pentad • Splenomegaly
- 12. Investigations • To confirm the disease • To know the cause • To stage the disease • To asses the status of patient • To plan the management
- 13. To confirm the disease • LFT –TB, DB • Fecal stercobilin, urobilin
- 14. To know the cause • Abdominal ultrasound • Triphasic CECT abdomen and pelvis • MRCP/ERCP/PTC • HIDA scan • EUS
- 28. HIDA scan
- 29. To assess the status of Patient • CBC • LFT – ALT, AST, ALP, PT/INR, Total and Direct bilirubin, Total protein, albumin • RFT, electrolyt4es • Chest Xray, HRCT chest
- 30. Tumor markers • CA-19-9 • CEA
- 31. To plan the management/staging • PET scan • Bone scan • Laparoscopy • Cardiological assessment
- 33. Management • Preoperative management – Hydration – D10, D5 – Nutrition – fat soluble vitamins (A,D,E,K) – Antibiotic prophylaxis – broad spectrum – Correction of anemia, hypoproteinemia – Symptomatic relief • Pruritus- cholestyramine 4g TDS • Pain- opoids vs non-opoids – Decompression
- 34. Preoperative biliary drainage • Indications : – Cholangitis – Severe pruritus – Neoadjuvant chemotherapy – Delayed surgery – Routine decompression (controversary) – Right hepatectomy – Portal vein embolisation
- 35. Surgery • According to cause • Aim : – To cure the disease – To relief symptoms – To improve quality of life
- 36. • Thank you