LETS HAVE A LOOK...

1. INVESTIGATIONS FOR DIAGNOSIS OF
THE CAUSE OF OBSTRUCTIVE
JAUNDICE

2.  Routine hematological investigations
 Liver Function Tests
 Urine Analysis
 Imaging

3. What do we want to
know????
1. Are the biochemical tests
suggestive of cholestasis?
2. Is the biliary tree dilated?
3. Is there suspicion for either
choledocholithiasis or
malignancy?
4. Is the patient a suitable
surgical candidate?
5. When would endoscopic
ultrasound/ MRCP be
useful?

4.  ROUTINE HEMATOLOGICAL TESTS :
Hb %- low in malignancy
Total Leucocyte Count and Differential
Leucocyte Count- increased in infections
like acute cholangitis
PT- normal is 12-16secs
a rise of >4 from control
or >1.5 times of control is significant

5. LIVER FUNCTION TESTS:
 Serum bilirubin : (Normal
value<1.0mg%...>3mg% is indicative)
Both conjugated &
unconjugated fractions are assessed
conjugated fraction is raised in
obstructive jaundice

6.  Serum Aspartate aminotransferase(SGOT) & Alanine
aminotransferase(SGPT) : mildly raised
 Serum alkaline phosphatase(ALP) : grossly elevated
 Gamma glutamyl transpeptidase(GGT) : raised

7. URINE ANALYSIS :
For presence of bilirubin &
urobilinogen
Bilirubin +
Urobilinogen Normally it is present in traces.
absent in obstructive jaundice

8. IMAGING
Ultrasonography
abdomen:
most useful, reliable ,
non-invasive and quick
investigation for diagnosis
of obstructive jaundice
Dilated biliary
radicles, stones in biliary
tree, mass or lesion in GB
head can be
demonstrated
Multiple secondaries
in liver can be
detected,favouring
diagnosis of malignancy

9. Endoscopic Retrograde Cholangio-
pancreatography(ERCP):
It has both diagnostic and therapeutic role in
obstructive jaundice
Prophylactic antibiotics are given before the
procedure as severe infection of the biliary tree
(cholangitis) and acute pancreatitis can occur in 1-
2% of patients

10. DISEASE
Choledocholithiasis
Choledochal cyst
Biliary stricture
Cholangiocarcinoma
DIAGNOSTIC USE
CBD stone can be detected as
filling defects in CBD or CHD
demonstrates Cystic
dilatation, stones,pancreato-
biliary maljunction & excludes
complete obstruction of bile
duct
Delineate the level of stricture
Assess distal tumors
Brush biopsy can be taken
THERAPEUTIC USE
Endoscopic sphincterotomy
& stone extraction
stenting
stenting

11. DISEASE
Acute pancreatitis
Chronic pancreatitis
Ca head of pancreas and
peri-ampullary carcinoma
DIAGNOSTIC USE
Acute biliary pancreatitis with
biliary
obstruction/cholangitis
Gold standard test:shows
dilated duct and stones in
it(chain of lakes appearance)
Long,irregular stricture in a
pancreatic duct
THERAPEUTIC USE
ERCP & papillotomy
Palliative stenting

12. Magnetic Resonance Cholangio-Pancreatography
(MRCP):
non-invasive technique that delineates bile
ducts very well,hence investigation of choice
in obstructive jaundice
96% sensitive and 99% specific

13. Contrast enhanced computed tomography(CECT)
scan of abdomen :
Identifies nature and extent of a
mass(stone,cholangiocarcinoma,pancreatic
carcinoma) & assess their operability

14. Endoscopy :
To diagnose pancreatic
carcinoma(seen as ulcerative
lesion in 2nd part of duodenum)
& take biopsy

15. Endoscopic ultrasonogram(EUS) :
Endoscopy aided ultrasonography
Detect stones in common bile duct,pancreatic
head mass.
Endosonoguided FNAC can be done

16. Ba meal follow
through :
In CA pancreas—
distortion of medial
border of duodenum
(inverted 3 sign)
In CA head of
pancreas—widening
of C-loop of
duodenum.

17. PERCUTANEOUS
TRANSHEPATIC
CHOLANGIOGRAPHY
:
Done in case of severe obstructive
jaundice where the lesion is suspected
to be in the proximal part of the biliary
tree , under the cover of antibiotics and
after control of any bleeding tendency
INDICATIONS:
Failure of ERCP
High biliary strictures
Klatskin tumor
Catheter drainage in high blocks