Obstructive

Jaundice

DR. ANMOL CHAUDHARY

DEPT OF GENERAL SURGERY
Definition

 Yellowish discolouration of skin, sclera & epithelial surfaces due to

raised bilirubin concentration in the blood.
Types of Jaundice

 Pre hepatic jaundice

 Excess production of bilirubin - Haemolytic
anaemia
 eg. Spherocytosis, Thalassaemia,
incompatible or massive blood transmission.
 Hepatic jaundice
 Defective processing of bilirubin in the liver.
 eg. Viral Hepatitis, toxic hepatitis, cirrhosis
of liver, Malignancy. Cholestatic drugs eg.
Chlorpromazin, methyl testosterone, PAS.
 Post hepatic or obstructive jaundice
 Blocked excretion of bile form the liver eg.
Stone in the CBD or on CA pancreas etc.
 Aetiology
Congenital causes
Biliary
atresia
Choledochus cyst
Acquired causes
Intra
Luminal obstruction (within the
lumen of CBD).
CBD calculus
Worm in CBD
Broken T-tube
Aetiology
(Cont…)
 Intra mural obstruction within the wall of the CBD.
 Cholangitis
 Cholangiocarcinoma
 Traumatic Stricture
 Ligation of Bile duct
 Bile duct injury
 Choledochus cyst
 Extra Mural obstruction (from outside the CBD ).
 Metastasis at porta hepatis.
 CA gall bladder > metastatic lymph node > growth migration through the
cystic duct
 CA head of pancreas
 Periampullary carcinoma
 Mirrizi’s syndrome
 Chronic pancreatitis – Mass in head of pancreas, calculi
 Clinical features
of

Obstructive
Jaundice

 Jaundice
Progressive or intermittent
Painless or painful.
 Pyrexia
 Pruritis
 Steatorrhoea
 Clay coloured or pale stool
 Dark urine
 Weight reduction
 Distaste for food.
 Swelling or lump in the abdomen.
 Bleeding Diathesis
Diagnosis

 Detailed Clinical history.

 Thorough Clinical examination.
 Laboratory investigation.
 Radiological Investigation.
 Laboratory
investigations
Hb.
WBC
S. bilirubin - Raised
Alkaline phosphatase – Raised
SGOT, SGPT.
Prothombin time (PT)
Vandenberg reaction – Direct
positive
Laboratory investigations
(Cont…)

 Urine examination for urobilinogen – Absent.

 Stool examination – Colour – Stercobilinogen
absent.
 Hypotonic Duodenography
 USG abdomen
 CT abdomen
 MRCP
 ERCP
 PTC
 Endoscopic sonography (EUS)
Problems of Surgery in
the Jaundiced patients

1. Obstruction & Sepsis

2. Impaired clotting
3. Risk of renal failure resulting from dehydration.
4. Impaired resistance to infection.
Pre Operative Preparation
In Obstructive Jaundice

1. Good Hydration
2. Correction of impaired clotting
- Vitamin K
- FFP
3. Antibiotics
4. Endoscopic Drainage of bile duct
- Stone removal
- Stenting
5. Precutaneous Transhepatic Cholangiogram &
Drainage.
Treatment

 According to cause of the obstructive jaundice.

Thank You