Obstructive Jaundice

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Obstructive Jaundice

• often due to obstruction of bile ducts by stone, stricture, tumour, etc
• may be due to intrahepatic, drug induced cholestasis
• bilirubin and alkaline phosphatase increased, transaminases largely normal

Symptoms

• Dark urine
• Pale, floating stools

History

• Country of origin (HBV)
• Duration of illness (hepatitis vs malignancy)
• Recent outbreak (HAV)
• Recent consumption of shellfish (HAV)
• IV drug abuse, recent injections / tattoos (HBV / HCV)
• Homosexuality / Prostitution (HBV)
• Blood transfusion (HBV / HCV)
• Alcohol
• Drugs (over 2-3 months)
  • recent anaesthetics
• Travel (HAV)
• Family History (Gilberts)
• Recent surgery on biliary tree
• Environment
• Fevers / Rigors

Examination

• Chronic Liver Disease
• Hepatomegaly
• Splenomegaly
• Palpable gallbladder
  • suggests Pancreatic Cancer
• Lymphadenopathy
  • suggests Lymphoma

Investigations

• FBC
  • raised WCC indicates infection
  • leucopenia in viral hepatitis
• Liver function tests
  • increased bilirubin
  • increased gamma-GT
  • increased alkaline phosphatase
  • AST / ALT raised in non-obstructive causes
• increased urinary bilirubin
• Viral Markers
• USS

Causes

Extrahepatic

• common bile duct jaundice
• carcinoma
  • head of pancreas
  • around Ampulla of Vater
• benign stricture of common bile duct
• enlarged porta hepatis
• sclerosing cholangitis
• Pancreatitis +/- pseudocyst
• Iatrogenic lesions

Intrahepatic

• Viral hepatitis
• Drugs
• Alcholic Hepatitis
• Cirrhosis
• Pregnancy
• Recurrent idiopathic cholestasis
• Some congenital disorders
• infiltration
• primary biliary cirrhosis
• PSC
• sepsis
• cholangiocarcinoma

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