The document provides a comprehensive overview of surgical jaundice, detailing its definition, types, epidemiology, aetiology, pathogenesis, clinical features, management, complications, and prognosis. It emphasizes the role of the liver and categorizes jaundice into pre-hepatic, hepatic, and post-hepatic types, while outlining various causes such as choledocholithiasis and neoplasms. Management strategies range from diagnostic investigations to surgical interventions and treatment complications, with patient prognosis dependent on the underlying cause.

1. SURGICAL JAUNDICE
Dr. ADEFEMI O. AFOLABI
HEPATOBILIARY & ENDOCRINE DIVISION
DEPARTMENT OF SURGERY
COLLEGE OF MEDICINE
UNIVERSITY OF IBADAN,
&
UNVERSITY COLLEGE HOSPITAL,
IBADAN, NIGERIA.

2. INTRODUCTION
• DEFINITION
• EPIDEMIOLOGY
• AETIOLOGY
• PATHOGENESIS
• CLINICAL FEATURES
• MANAGEMENT
• COMPLICATIONS
• PROGNOSIS

3. DEFINITION
• DEFINE JAUNDICE
• TYPES OF JAUNDICE- CLASSIFY
• WITH RESPECT TO THE
PATHOGENESIS- THE LIVER IS
CENTRAL
• PRE-HEPATIC, HEPATIC, POST-HEPATIC
• OBSTRUCTIVE JAUNDICE
• AMENABLE/TREATABLE BY SURGERY

4. EPIDEMIOLOGY
DISTRIBUTION
• GEOGRAPHICAL
• AGE
• GENDER

5. AETIOLOGY
• AGE
• GENDER
• GEOGRAPHICAL
• LUMEN- INTRA-, MURAL,
EXTRA-
• PNEMONIC- TINCABED

6. AETIOLOGY
• CHOLEDOCHOLITHIASIS
• CHOLEDOCHAL CYST
• BILIARY ATRESIA & OTHER
BILIARY ANATOMICAL
VARIATIONS

7. AETIOLOGY
• NEOPLASMS- CARCINOMA, HEAD
OF PANCREAS,
CHOLANGIOCARCINOMA,
PERIAMPULLARY CARCINOMA,
CARCINOMA OF THE DUODENUM
• LYMPHADENOPATHY-PORTA
HEPATIS
• TRAUMATIC- POST
CHOLECYSECTOMY

8. PATHOGENESIS
• AETIOLOGICAL FACTORS-
CALCULOUS, NEOPLASTIC
• BILIARY TREE OBSTRUCTION
• STASIS
• HEPATOCELLULAR DYSFUNCTION
• CHOLANGITIS
• MALABSORPTION

9. CLINICAL FEATURES
• WITH RESPECT TO AETIOLOGY &
THE EFFECTS OF OBSTRUCTION
• JAUNDICE, PRURITUS, DARK
URINE, PALE STOOLS,
PAIN/COLIC, WEIGHT LOSS,
VOMITING, ANOREXIA, ANAEMIA,
ABDOMINAL MASS,
HEPATOMEGALY, GALL BLADDER
DISTENSION, ASCITES

10. MANAGEMENT
• CONFIRM CLINICAL
DIAGNOSIS
• ASSESS PHYSIOLOGICAL
STATUS
• INVESTIGATE FOR
SURGERY

11. INVESTIGATIONS
• ABDOMINAL ULTRASOUND
• ABDOMINAL CT SCAN
• ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATO-
-GRAPHY

12. INVESTIGATIONS
• SERUM BILIRUBIN, ALKALINE
PHOSPHATASE, AST, ALT,
ALBUMIN, GLOBULIN,
CHOLESTEROL
• PROTHOMBIN TIME (INR), PTTK
• URINALYSIS, SERUM E/U& Cr.,

13. CT ABDOMEN

14. CT ABDOMEN

15. DISTENDED GALL BLADDER

16. BILIARY BYPASS

17. CT ABDOMEN(DA)

18. LUNG METASTASES OF GALL
BLADDER CANCER

19. INVESTIGATIONS
• FULL BLOOD COUNT, GROUP &
CROSS MATCH BLOOD
• HAEMOGLOBIN
ELECTROPHORESIS
• BLOOD CULTURE
• CHEST X-RAY, ABDOMINAL X-RAY
• TRANSHEPATIC
CHOLANGIOGRAPHY

20. TREATMENT
• OPTIMISE THE PATIENT-CORRECT
ANAEMIA, ELECTROLYTE
ABNORMALITIES, REHYDRATE,
BLEEDING DISORDER(VITAMIN K),
NUTRITION-CHO, PROTEIN,
• BOWEL PREPARATION,
PERIOPERATIVE ANTIBIOTICS

21. TREATMENT
• CHOLEDOCHOLITHIASIS-
INTRAOPERATIVE CHOLANGIGRAPHY
CHOLECYSTECTOMY-
OPEN/LAPAROSCOPIC,
EXPLORATION OF COMMON BILE
DUCT, INSERTION OF T-TUBE-
MANAGEMENT OF TUBE,
ENDOSCOPIC SPHINCTEROTOMY
• CARCINOMA- WHIPPLE’S PROCEDURE,

22. T-TUBE CHOLANGIOGRAM

23. PALLIATIVE TREATMENT
• ENDOSCOPIC INSERTION OF
BILIARY STENT
• BYPASS SURGERY
CHOLECYSTOJEJUNOSTOMY OR
CHOLEDOCHOJEJUNOSTOMY,GAS
TROJEJUNOSTOMY, &
JEJUNOJEJUNOSTOMY-SIDE TO
SIDE OR ROUX-EN-Y

24. COMPLICATIONS OF
TREATMENT
• BLEEDING
• SEPTICAEMIA
• RENAL FAILURE
• ANASTOMOTIC DEHISCENCE
• OTHERS

25. PROGNOSIS
•DEPENDS ON THE
AETIOLOGY AND THE
STAGE OF
PRESENTATION

26. CONCLUSIONS
DO IT RIGHT THE FIRST
TIME, BECAUSE LIFE IS
NOT A DRESS REHEARSAL
BOB GASS