The Obstructive Jaundice is not occurred due to deviation of the physiology of the liver by own, rather it is happened either postoperative or congenital or sudden obstruction of the bile channel or by drugs inducing. Obstructive jaundice isn't an illness in itself yet a side effect of a hidden condition including the liver, the gallbladder or the pancreas. It will as a rule require careful intercession, and is otherwise called careful jaundice.
The most widely recognized reason for obstructive jaundice here is gallstones causing a blockage in the waste of pathway of bile. The liver produces bile to process food and convey side effects to the digestive organs for disposal. At the point when bile waste is hindered, bilirubin - a result of red cell reusing - develops in the liver and spills over to the circulation system, making the skin and whites of eyes become yellowish. Recognizing the potential reasons for obstructive jaundice is significant. While the normal causes are connected with gallstone sickness, the more evil causes are connected with disease (pancreatic malignant growth, bile channel malignant growth, or less regularly liver disease). One of the primary distinctive side effects among harmless and dangerous causes is torment.
Agonizing obstructive jaundice is generally connected with gallstones, while easy obstructive jaundice will in general be connected with growths. The justification for this distinction is that stones will quite often hold onto microbes and cause bile pipe disease, bringing about agony and fever.
Strangely, as agony is certainly not a critical element for dangerous causes, patients with cancers will more often than not look for master help later. These patients may likewise have troubling side effects of weight reduction and loss of craving.
Causation / Etiology - Obstructive jaundice
A. Intrahepatic Cholestasis
Drugs: Largactil, PAS, Arsenic, Sulphonamides, Nitrofurantoin, etc.
Hormones: Anabolic steroid, Methyltestosterone.
Oral contraceptives
B. Extrahepatic causes(CBD obstruction)
Causes in the lumen
C.B.D stones
Ascaris worm or ova or cysts
Stone in Pancreatic duct
Causes in the wall
Periampullary carcinoma
Stricture of C.B.D or common hepatic duct
Choledochal cyst
Stenosis of a splinter of Oddi
Common bile duct or common hepatic duct growth
Pressure from outside
Ca- head of the pancreas
Chronic pancreatitis
Lymph node of Porta hepatis
Surgical Jaundice:
Jaundice amenable to surgical treatment is surgical jaundice. Most obstructive jaundice or post-hepatic jaundice belong to this group.
Latent jaundice:
Raised serum bilirubin above 1 mg to 2 mg/DL without clinical jaundice.
Diagnosis
A.
History
Age - Jaundice in newborns and infants is commonly caused by erythroblastosis fetalis, atresia of bile ducts, physiological jaundice, congenital spherocytosis.
Sex - Malignancy and alcoholic cirrhosis are more common in males. Stones are almost equal in males and females.
Duration - Jaundice due to malignancy is usually of shorter duration. Jaundice for a longer duration is most likely to be benign surgical jaundice.
Onset - Insidious in obstructive jaundice. Sudden in a matter of hours in an otherwise healthy individual with nausea, anorexia and aversion to smoking (in smokers) points to infective hepatitis. If anybody nurses the infective hepatitis patient can be affected by obstructive jaundice or hepatitis.
Jaundice following operation -
On biliary tract suggest residual calculus, traumatic stricture of the bile duct, hepatitis, or postoperative pancreatitis.
For removal of a malignant growth, suggest hepatic metastasis.
Jaundice with previous dyspepsia, fat indigestion, and biliary colic suggest cholelithiasis or choledocholithiasis.
Past history - Hepatitis due to blood transfusion or parenteral infection.
Previous difficult cholecystectomy.
Personal history - Alcohol or contact with a patient of infective hepatitis.
B.
Symptomatology
Progressive jaundice - Malignant obstruction
Intermittent jaundice - Commonly C.B.D stone.
Painless - Usually malignant jaundice (Ca- head of the pancreas)
Painful - Biliary colicky pain suggests stone. In pancreatitis, epigastric pain is continuous and radiates to the back. Upper abdominal dull, dragging pain is due to hepatitis and cirrhosis.
Pyrexia or fever - History of influenza-like fever followed by the appearance of jaundice is generally due to hepatitis. Jaundice with spiky temperature and chill usually indicate cholangitis associated with impacted stone in the common bile duct. Fever may also present in cirrhosis and neoplastic diseases.
Pruritus - The presence of pruritus (itchy) along with jaundice is common in obstructive jaundice due to irritation of cutaneous nerves by retained bile salts.
Stool and its color
The voluminous and clay-colored stool is usually prevented in obstructive jaundice due to the absence of stercobilin. In hemolytic jaundice, the stool is yellow-colored.
Swelling or lump abdomen - Palpable gall bladder, Ca- head pancreas, hepatomegaly with splenomegaly.
The desire for food - Marked loss of appetite is more common in Ca and Hepatitis.
Dark urine
Loss of weight
C.
Clinical examination
Eye: (Depth of jaundice) -
Mild or lemon yellow color - Hemolytic jaundice
Orange-yellow - Hepatocellular jaundice
Greenish-yellow - Obstructive jaundice
Tongue - dry, coated tongue with fetor hepatitis in hepatic failure.
Neck - Vircow's gland ( metastasis left supraclavicular lymph node - Ca head of the pancreas, gastric Ca.
Gynecomastia - Cirrhosis of the liver
Skin - Scratch marks due to itching.
Abdomen - looks normal
Investigation
Examination of urine - Absence of urobilinogen in obstruction in C.B.D.
Stool - Absence of stercobilin in complete C.B.D obstruction
Occult blood- Periampullary carcinoma, alimentary carcinoma, or portal hypertension.
Blood - Low W.B.C count with lymphocytosis, Low Hb%, in malignancy, Leukocytosis in cholangitis. B.T, C.T, P.T.
L.F.T
Serum bilirubin - In obstructive jaundice, as high up to 20mgm% or more
Serum Albumin - Below 3gm%, suggest gross liver damage
Alteration of A/G ratio-severe liver damage
Serum Alkaline phosphatase - Above 30K-A units suggests obstructive jaundice.
Serum Transaminases (S.G.O.T, S.G.P.T)- very high in hepatitis and liver damage
Prothrombin time(P.T) and Platelet count-severe impairment indication liver damage.
Radiology
Chest X-ray to exclude metastasis
St. X-ray abdomen
USG
Ba-meal X-ray stomach and duodenum
P.T.C - Percutaneous transhepatic cholangiogram)
I.V.C - Intravenous cholangiogram
E.R.C.P - Endoscopic retrograde cholangiopancreatography
C.T scan - Computerized tomography.
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