Obtructive jaundice Dr Hatem El Gohary
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Obstructive jaundice is caused by a blockage of the common bile duct, resulting in high bilirubin levels seen as yellowing of the skin and eyes. It can be caused by gallstones blocking the cystic duct or common bile duct, or by cancers of the pancreas or bile duct. Patients experience jaundice, itching, pain, fever and pale stool. Investigations include blood tests showing elevated bilirubin and liver enzymes, as well as imaging like ultrasound or MRI to identify gallstones or tumors blocking the bile duct. Treatment depends on the cause, with gallstones removed through ERCP or surgery, while malignant tumors may require Whipple's procedure.
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Obstructive jaundice
1. Obstructive jaundice results from obstruction of bile flow from the liver to the duodenum, causing bilirubin levels to rise above 2.5mg/dL and resulting in jaundice.
2. The top 3 causes of obstructive jaundice are choledocholithiasis, strictures, and pancreatic cancer.
3. Evaluation involves clinical examination, blood tests of liver function and markers, ultrasound of the bile ducts, and CT or ERCP to visualize the biliary tree and determine the level and cause of obstruction.
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This document discusses the investigations and management of surgical jaundice. It outlines the various laboratory tests, imaging studies, and other diagnostic evaluations used to confirm the diagnosis and identify the underlying cause of obstructive jaundice. This includes liver function tests, ultrasound, CT, MRCP, ERCP, and in some cases biopsy or tumor markers. The document then reviews the treatment approaches for common causes like gallstones, pancreatic cancer, and bile duct cancers. These involve endoscopic or surgical procedures to relieve the obstruction like ERCP, cholecystectomy, bile duct exploration, bypass procedures, and resection when possible. Postoperative jaundice is also discussed.
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This document provides a case history, examination findings, investigations, and management plan for a 68-year-old male presenting with jaundice, abdominal pain, and itching for 20 days. Examination found jaundice, hepatomegaly, and abdominal tenderness. Liver function tests showed elevated bilirubin and alkaline phosphatase. Ultrasound and CT scan identified a mass in the periampullary region. The patient was diagnosed with obstructive jaundice likely due to a periampullary tumor and treated with antibiotics and pain medication.
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The patient is a 65-year-old male with a history of chronic pancreatitis who presents with jaundice, weight loss, clay-colored stools, and itching. On examination, he appears jaundiced and emaciated with scratch marks and a palpable mass in the right upper abdomen. Imaging shows a mass in the head of the pancreas causing dilation of the pancreatic and bile ducts. Given the clinical findings and imaging results, pancreatic cancer is suspected. Biopsy of the mass confirms pancreatic adenocarcinoma. Surgical resection offers the only chance of cure but many patients have advanced disease at presentation.
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2. The top 3 causes of obstructive jaundice are choledocholithiasis, strictures, and pancreatic cancer.
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by
Dr.AWS NIDHAM KREADY
M.B.Ch.B
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This document provides information on jaundice, including:
1. It classifies jaundice as normal, hemolytic, hepatitic, or obstructive based on bilirubin levels and the underlying cause.
2. It describes the clinical signs of jaundice including skin discoloration and notes that pruritus indicates obstructive jaundice.
3. It outlines the diagnostic approach to a patient with jaundice including history, physical exam, lab tests, and imaging modalities like ultrasound, MRCP, and ERCP.
Obstructive jaundice
This document provides information about jaundice and obstruction of the biliary tract. It begins with an overview of the causes of yellow discoloration of the skin and mucous membranes, which is caused by bilirubin accumulation. It then describes the breakdown of red blood cells and how bilirubin is processed and excreted. The document outlines various causes of obstructive jaundice including gallstones, strictures, tumors, and external compression. Investigation methods and treatment approaches for different biliary obstructions are also summarized.
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Surgical jaundice
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1. It defines jaundice and surgical jaundice, and classifies jaundice into pre-hepatic, hepatic, and post-hepatic types.
2. It describes the anatomy and physiology of the biliary tract and bilirubin metabolism.
3. Common causes of obstructive jaundice include gallstones, cancer, strictures, and inflammation. A thorough history and physical exam can help identify the cause.
4. Investigations include blood tests, imaging like ultrasound and MRCP, and procedures like ERCP. The goal is to determine the specific cause and level of obstruction.
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Obstructive jaundice 1
Obstructive jaundice is caused by a blockage of the bile ducts that prevents bile from flowing from the liver to the small intestine. This blockage can be due to gallstones, pancreatic cancer, or other cancers. It causes jaundice (yellowing of the skin and eyes) as well as other symptoms like itching, abdominal pain, dark urine and pale stool. Diagnosis involves blood tests and imaging scans like ultrasound or MRI. Treatment depends on the underlying cause but may include antibiotics, ERCP, surgery, or transplantation if the liver is severely damaged.
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This document provides an overview of jaundice and its causes. It discusses the stages of jaundice progression based on bilirubin levels and the sites affected. Jaundice can be pre-hepatic due to hemolysis, hepatic due to liver disease, or post-hepatic/cholestatic due to biliary obstruction. A thorough history and physical exam are important to determine the underlying cause and type of jaundice. Lab tests and further imaging may then be used to make a specific diagnosis.
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This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
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• Greetings from “Surgical Educator”
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2. It describes the clinical signs of jaundice including skin discoloration and notes that pruritus indicates obstructive jaundice.
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1. It defines jaundice and surgical jaundice, and classifies jaundice into pre-hepatic, hepatic, and post-hepatic types.
2. It describes the anatomy and physiology of the biliary tract and bilirubin metabolism.
3. Common causes of obstructive jaundice include gallstones, cancer, strictures, and inflammation. A thorough history and physical exam can help identify the cause.
4. Investigations include blood tests, imaging like ultrasound and MRCP, and procedures like ERCP. The goal is to determine the specific cause and level of obstruction.
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This document provides an overview of jaundice and its causes. It discusses the stages of jaundice progression based on bilirubin levels and the sites affected. Jaundice can be pre-hepatic due to hemolysis, hepatic due to liver disease, or post-hepatic/cholestatic due to biliary obstruction. A thorough history and physical exam are important to determine the underlying cause and type of jaundice. Lab tests and further imaging may then be used to make a specific diagnosis.
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1. The document discusses various potential causes of a mass in the right iliac fossa, including appendicitis, appendicular abscess, carcinoid tumors of the appendix, mucoceles, adenocarcinoma, tuberculosis, Crohn's disease, carcinoma of the caecum, actinomycosis, amoebiasis, mesenteric cysts, intussusception, iliopsoas abscess, retroperitoneal tumors, aneurysms, and more rare causes.
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liver including the chance of developing a cholangiocarcinoma. Though the disease is rampant in East Asian countries isolated cases are seen
even on the Indian subcontinent. Since experience is lacking in our country to treat this uncommon condition awareness of this condition will
enable the surgeon diagnose and develop a proper surgical treatment plan which best suits the patient depending upon the severity of the
disease process. A brief review of the etiopathogenesis, diagnosis and management is presented in this paper.
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Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
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• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
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Neonatal jaundice is a yellowish discoloration of the skin and eyes due to high bilirubin levels above 5 mg/dl. It can be physiological, caused by increased breakdown of fetal red blood cells, or pathological within the first 24 hours. Pathological jaundice can be unconjugated due to hemolytic issues like ABO incompatibility or non-hemolytic, or conjugated due to extrahepatic issues like biliary atresia or hepatic issues like hepatitis B. Biliary atresia involves inflammatory destruction of the bile ducts causing progressive jaundice, pale stool, and dark urine. It is treated with hepaticojejunostomy or Kasai procedure depending on the type
Jaundice
This document provides an overview of jaundice and its causes. It defines jaundice as a yellowish discoloration of the skin and eyes. Jaundice can be classified as pre-hepatic (haemolytic), hepatocellular, or obstructive based on its underlying mechanism. Common causes discussed include viral hepatitis, alcoholic liver disease, gallstones, and tumors. The document outlines approaches to evaluating a jaundiced patient through history, examination, and laboratory and imaging tests. It also describes treatment principles and specific therapies for acute viral hepatitis and liver failure.
Obstructive jaundice: concerned investigations
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malignant BANSAL (Surgical Obstructive Jaundice)
1. The document discusses various types of pancreatic and biliary cancers including carcinoma of the head of pancreas, periampullary carcinoma, cholangiocarcinoma, and carcinoma of the gallbladder.
2. Treatment options are discussed including surgical resection procedures like the Whipple procedure or palliative options for unresectable tumors focusing on relieving jaundice, pain, or duodenal obstruction.
3. Complications of resection and palliative procedures are also summarized along with prognosis for different tumor types and stages.
Biliary atresia- Obstructive jaundice/ Pediatric surgery
Dear Viewers,
Greetings from “ Surgical Educator”
Today I have uploaded a video on one of the congenital causes for obstructive jaundice- Biliary Atresia. In this episode, I am discussing about the etiology, types, clinical features, investigations, treatment and surgical outcome of Biliary Atresia. I hope you will enjoy the video. You can watch all my surgical teaching video casts in the following link: surgicaleducator.blogspot.com.
Surgical jaundice
This document discusses surgical jaundice, defined as jaundice that can be treated surgically, usually due to extrahepatic biliary obstruction. It covers the definition, causes, pathophysiology, clinical evaluation and treatment of surgical jaundice. The most common cause is gallstones, which can become lodged in the common bile duct. Physical examination may reveal jaundice and abdominal tenderness. Imaging studies can locate the obstruction and determine if it is intrahepatic or extrahepatic. Treatment involves addressing the underlying cause, often through surgery such as cholecystectomy for gallstones or bypass procedures for cancer.
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Biliary atresia- Obstructive jaundice/ Pediatric surgery
Biliary atresia- Obstructive jaundice/ Pediatric surgery
Cholangiocarcinoma: Pathology, diagnosis and treatment.
Cholangiocarcinoma: Pathology, diagnosis and treatment.
Similar to Obtructive jaundice Dr Hatem El Gohary
Pancreatic Cancer ( Malignant Obstructive Jaundice )
A 52-year-old male patient presented with progressive jaundice, itching, weight loss, and abdominal pain over 6 months. Imaging showed a mass in the distal common bile duct causing dilation of the intrahepatic and extrahepatic bile ducts. Biopsy of the mass via ERCP confirmed malignant distal common bile duct stricture, indicating late stage pancreatic cancer. Treatment options were discussed based on disease stage, including surgery for resectable disease and chemotherapy with or without radiation for locally advanced or metastatic disease.
Obstructivejaundice 130530070611-phpapp01 (1)
This document describes a case of obstructive jaundice in an 82-year-old male presenting with progressive jaundice, itching, weight loss, and pale stools. Examination found jaundice, scratch marks, and a palpable gallbladder. Investigations showed elevated bilirubin and alkaline phosphatase consistent with obstructive jaundice. Imaging found a solid mass in the distal common bile duct. The causes, pathophysiology, investigations, and management of obstructive jaundice are then reviewed, focusing on endoscopic or surgical interventions depending on the underlying cause such as gallstones, pancreatic cancer, cholangiocarcinoma. Prognosis depends on factors like type of obstruction and patient
jaundice-160414200805.pptx
A 80-year-old African American female presents with 2 months of jaundice. She had her gallbladder removed 2 months ago for gallstones but the jaundice did not fully resolve. Her examination shows jaundice and she reports tea-colored urine for 1 month. CT scan found nondilated bile ducts. The persistent jaundice after cholecystectomy suggests another cause of obstruction or underlying liver disease may be present.
OBSTRUCTIVE JAUNDICE.pptx
Obstructive jaundice is a condition characterized by the accumulation of bilirubin in the blood due to an obstruction in the bile ducts. The bile ducts are responsible for transporting bile, a yellowish-green fluid produced by the liver, to the intestines to aid in digestion. When the flow of bile is hindered or blocked, bilirubin, which is a waste product of red blood cells, cannot be properly eliminated from the body, leading to its accumulation in the bloodstream.
The most common cause of obstructive jaundice is the presence of a blockage in the bile ducts, usually caused by gallstones, tumors, or strictures (narrowing) of the ducts. This blockage prevents bile from flowing freely, resulting in its buildup in the liver and subsequently in the blood. As a result, individuals with obstructive jaundice may exhibit yellowing of the skin, eyes, and mucous membranes, which is the hallmark symptom of jaundice.
Jaundice
This document discusses jaundice and its causes. It begins by defining jaundice as a yellowing of the skin and eyes caused by high bilirubin levels. It then explains bilirubin metabolism and the different mechanisms that can cause jaundice, such as increased bilirubin production, impaired uptake/conjugation, or impaired bilirubin excretion/bile flow. The main categories of jaundice are hemolytic, hepatocellular, and obstructive. The document goes on to describe specific causes, classifications, and laboratory/imaging tests used to investigate the jaundiced patient, including ultrasound, CT, ERCP, and liver biopsy. Surgical causes like gallstones,
Obstructive jaundice
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
jaundice-(three types)- pre hepatic, hepatic , post hepatic
Jaundice is about increase level of belarubin in blood
Jaundice
This patient, an 80-year-old African American female, presented with persistent jaundice for 2 months following a laparoscopic cholecystectomy for gallstones. Her jaundice initially decreased after surgery but returned, and she now has itching and tea-colored urine. Her weight has decreased 30 pounds over the past year despite good appetite. Physical exam showed jaundice but no signs of chronic liver disease. CT scan found nondilated bile ducts. The persistent jaundice following cholecystectomy suggests an underlying cause needs to be identified.
OBS Jaundice.pptx
This document provides information on obstructive jaundice, including:
- Causes of obstructive jaundice include gallstones, tumors, strictures.
- Clinical features include jaundice, itching, steatorrhea.
- Investigations include liver function tests, ultrasound, CT, MRCP, ERCP.
- ERCP allows both diagnosis and treatment by sphincterotomy and stone extraction.
- Surgical management of stones includes open exploration or laparoscopic removal.
- Benign strictures are often post-surgical and may require stenting or reconstruction.
Jaundice general survey
This document provides an overview of jaundice, including definitions, causes, signs and symptoms, and approaches to evaluation and diagnosis. Key points include:
- Jaundice is defined as a yellowish discoloration of the skin and eyes caused by high bilirubin levels in the blood.
- It can be caused by pre-hepatic (hemolytic), hepatic, or post-hepatic (obstructive) conditions that disrupt bilirubin metabolism.
- Evaluation involves history, physical exam, and lab tests including liver enzymes and bilirubin levels to determine the type and cause of jaundice.
- Further imaging like ultrasound and MRCP may be needed to identify obstructions
Approach to Jaundice
This presentation provides a overview to the clinical approach to jaundice. Sleisenger based presentation.
Laboratory Diagnosis of Jaundice
This document discusses laboratory diagnosis of jaundice. It begins by defining jaundice and explaining causes such as overproduction or defective transport of bilirubin. Serum bilirubin levels and bilirubin metabolism are described. Jaundice is classified based on bilirubin type, etiology, and site of disease. Differential diagnosis of pre-hepatic, hepatocellular and obstructive jaundice is provided based on bilirubin levels, urine tests, and other features. Specific conditions like Gilbert's syndrome and viral hepatitis are explained. Evaluation of acute liver injury focuses on markers like ALT, AST, ALP and their patterns in hepatocellular vs cholestatic disease.
Gi gs case conference 5月2013
This document discusses the case of a 63-year-old male patient presenting with jaundice, abdominal pain, weight loss and clay-colored stools. Imaging and biopsy revealed hilar cholangiocarcinoma (Klatskin tumor) involving the left and right hepatic ducts. The patient underwent percutaneous biliary drainage and right hepaticojejunostomy. The document provides details on the diagnosis, staging, risk factors, treatments including surgery and chemotherapy, and prognosis for hilar cholangiocarcinoma.
JAUNDICE. GI disorders ... everything...
Jaundice, also known as hyperbilirubinemia, is caused by an excess of bilirubin in the blood which results in a yellowish discoloration of the skin and eyes. There are three main types of jaundice: hemolytic, which occurs due to the breakdown of red blood cells; hepatocellular, which results from liver damage; and obstructive, which is caused by a blockage in the bile ducts preventing bilirubin excretion. Jaundice is diagnosed based on symptoms, lab tests of bilirubin levels, and imaging exams. Treatment depends on the underlying cause but may include medications to reduce bilirubin levels, dietary changes, and procedures
Hepato Biliary.pptx
The document discusses diseases of the gallbladder and biliary tree. It describes the anatomy and physiology of the gallbladder and discusses conditions like gallstones, acute cholecystitis, and obstructive jaundice. Gallstones are the most common pathology of the biliary tract and can cause complications within the gallbladder or bile ducts. Acute cholecystitis is an inflammation of the gallbladder usually due to a gallstone obstructing the cystic duct. Obstructive jaundice is caused by an obstruction of the biliary tree above the entry of the pancreatic duct and results in a yellowish discoloration of skin and eyes.
Obstructive jaundice.pptx
This document provides an overview of the approach to surgical jaundice. It defines obstructive jaundice as a failure of bile to reach the intestine due to a mechanical obstruction. The causes of obstructive jaundice include gallstones, tumors, strictures, and pancreatitis. A thorough history, physical exam, and lab and imaging tests are needed to determine the cause and guide treatment, which may include procedures like ERCP or surgery to relieve the obstruction.
obstructive_jaundice.pptx
1. The document discusses obstructive jaundice, describing its causes as being related to blockage of bile flow from the liver. This can be caused by gallstones, pancreatic cancer, or other tumors.
2. Clinical features include jaundice, abdominal pain, and elevated bilirubin levels. Imaging tests like ultrasound, CT, MRCP, and ERCP can help locate and identify obstructions.
3. Treatment depends on the underlying cause but may involve surgery to remove gallstones or tumors, or ERCP to clear ducts endoscopically. Prognosis depends on factors like type of obstruction and patient health.
10 - acute abdomen 1
The document discusses the acute abdomen, which is characterized by severe abdominal pain requiring urgent treatment. The differential diagnosis for an acute abdomen includes life-threatening to benign conditions. Radiological exams like ultrasound, CT scans, and X-rays can help evaluate potential causes like acute hepatitis, gallstones, cholecystitis, ulcers, kidney stones, and more. Acute viral hepatitis often presents with fever, pain, and jaundice along with elevated liver enzymes. Gallstones and cholecystitis are evaluated on ultrasound by looking at wall thickness, Murphy's sign, and blood flow changes in the gallbladder.
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Pancreatic Cancer ( Malignant Obstructive Jaundice )
Pancreatic Cancer ( Malignant Obstructive Jaundice )
jaundice-(three types)- pre hepatic, hepatic , post hepatic
jaundice-(three types)- pre hepatic, hepatic , post hepatic
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1. Surgical wounds are at risk of infection if the protective epithelial surfaces are broken through trauma or surgery. The body has chemical, humoral, and cellular defenses against infection but these can be compromised by various risk factors.
2. Common signs of a surgical wound infection include fever, pain, pus or discharge, redness, swelling, and tenderness at the wound site. Infections are classified based on degree of contamination from clean to dirty.
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Hirschsprung disease is a developmental disorder of the enteric nervous system characterized by the absence of ganglion cells in the distal colon, resulting in functional obstruction. It is caused by congenital aganglionosis of the distal bowel. Diagnosis involves symptoms of delayed meconium passage and chronic constipation, as well as barium enema and rectal biopsy showing aganglionosis. Treatment involves rehydration, colostomy, and resection of the aganglionic segment via procedures like Swenson or Duhamel. Imperforate anus is caused by defects in formation of the posterior urorectal septum. It can be low or high and is sometimes associated with VACTERL
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- A hernia is a protrusion of an organ or tissue through an abnormal opening in the walls of its containing cavity. Common types include congenital, indirect inguinal, direct inguinal, and femoral hernias.
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Obtructive jaundice Dr Hatem El Gohary
- 1. OBSTRUCTIVE JAUNDICE Dr Hatem EL Gohary Lecturer of General Surgery
- 3. Definition of jaundice Yellowish discoloration of sclera and skin due to high levels of bilirubin which is manifested above 2 mg/dl.
- 5. Causes Calcular: Gall bladder stones passing through cystic duct to obstruct the common bile duct. Malignant: - Cancer head of the Pancreas. - Cholangiocarcinoma.
- 6. Clinical Picture Jaundice (sclera – Palate) Itching Pain (Cholangitis) Fever (Cholangitis) Dark urine Pale stool.
- 7. Investigations Laboratory: -Total bilirubin and Direct bilirubin(Conjugated) Direct bilirubin more elevated than indirect. - Liver Enzymes elevated. - Hepatitis Markers (A, B & C). - Coagulation Profile (Prothrombin time).
- 8. Radiological: -Ultrasound Abdomen showing dilated CBD + stones. - CT and MRI Abdomen showing pancreatic tumor and liver metastasis. - ERCP (Endoscopic retrograde cholangio- pancreatography) diagnostic and therapeutic.
- 9. Treatment General: IV fluids – Urine output chart – Vitamin K –Broad spectrum Antibiotics. Calcular: - Removal of CBD stones either by ERCP or By Surgical CBD Exploration + Cholecystectomy. Malignant: Whipple’s Operation.