Pathophysiology of obstructive jaundice slideshare. Pdf pathophysiology of increased intestinal permeability. Obstructive jaundice an overview sciencedirect topics. A patient presenting with obstructive jaundice will need medical investigation to determine the cause of the obstruction and the treatment required. Tuberculosis tb of the porta hepatis presenting with obstructive jaundice mimicking a malignant biliary tumor.
Jaundice and asymptomatic hyperbilirubinemia are common clinical problems that can be caused by a variety of disorders, including bilirubin overproduction, impaired bilirubin conjugation, biliary obstruction, and hepatic inflammation. An algorithmic approach to the evaluation of jaundice in adults. Obstructive jaundice causes, symptoms, pathophysiology. Obstructive jaundice may be caused by a gallstone lodged in the common bile duct, carcinoma of the pancreas, bile duct or ampulla and, rarely, benign biliary strictures.
The modern way of life and nourishment causes the increased incidence of cholesterol gallstones3, and the characteristic of the nourishment in the continental croatia is the food rich in fats. Hepatitis a is usually a selflimited illness that presents with acute onset of jaundice. Disorders of the biliary tract affect a significant portion of the worldwide population, and the overwhelming majority of cases are attributable to cholelithiasis gallstones. Obstructive jaundice is a fairly common presentation to the emergency department and surgical teams. Ppt jaundice powerpoint presentation free to download. Intestinal bacteria convert some of the extra bilirubin into urobilinogen, some of which is reabsorbed and is excreted. Among the different types of malignancy causing obstructive jaundice, pancreatic cancer and cholangiocarcinoma were the most common, followed by the other malignancies category table 1. Obstructive jaundice is a common problem in daily clinical practice. As a reminder, jaundice, or icterus refers to the yellowish discoloration of the skin, sclerae, and mucous membranes caused by retention of bilirubin andor its conjugates.
See also liver structure and function and evaluation of the patient with a liver disorder. Obstructive jaundice center for advanced digestive care. This study was done to assess the role of ultrasound in diagnosis of obstructive jaundice and to identify the most common causes and symptoms. Symptoms of obstructive jaundice include yellow eyes and skin, abdominal pain, and fever. Yellow discoloration of sclera, skin, mucous membranes due to deposition of bile pigment. Pancreatic cancer, when it occurs near the tube connecting the pancreas to the intestines. Biliary obstruction associated with pancreatitis is observed most commonly in patients with dilated pancreatic ducts due to either inflammation with fibrosis of the pancreas or a pseudocyst. Congenital obliteration of the bile ducts is a rare type.
Chapter 80 obstructive jaundice francis aba uba mohammed a. This article highlights the diagnosis, complications and treatment. If obstructive jaundice is left untreated, there is a high risk of infection when bilirubin overflows into the bloodstream. In the united states, 20% of persons older than 65 years have gallstones and 1 million newly diagnosed cases of gallstones are reported each year. Aims and objectives study the clinical history and presentation of obstructive jaundice. He was not able to observe rupture of the bile capillaries after biliary obstruction and laid emphasis on early changes in the liver cells themselves.
The study took place in different khartoum clinical centers and hospitals in the period between jan 2014 and july 2014. What is the pathophysiology of jaundice in biliary. In the intestine, deconjugation of the bilirubin by intestinal bacteria. Neonatal hyperbilirubinaemia is usually physiologic, unconjugated, and selflimited. A pubmed was searched for relevant articles published up to august 2016. Also called mechanical, cholestatic jaundice or surgical jaundice. Gudelj graanin et al obstructive jaundice in continental croatia, coll. Main causes of obstructive jaundice bile duct in the lumen of the common bile duct gallstones, parasites.
Bilirubin is yellow, and this gives the characteristic yellow appearance of jaundice in the skin, eyes, and mucous membranes. Systemic effects immunity increased bacterial translocation from the gut in the setting of bile duct obstruction wound healing delayed wound healing and a high incidence of wound dehiscence and incisional hernia have been observed in patients undergoing surgery to relieve obstructive jaundice 11. Pathophysiological consequences of obstructive jaundice. Most easily recognised in fairskinned individuals, difficult in darkly pigmented patients most easily seen in the sclera, under tongue yellowgreen in appearance in chronic, severe obstructive jaundice biliverdin. Posthepatic postliver jaundice, also called obstructive jaundice, is caused by an interruption to the drainage of bile containing conjugated bilirubin in the biliary system. Key words obstructive jaundice hepatocellular carcinoma.
Condition where blockage of the flow of bile from the liver causes overspill of bile products into the blood and incomplete bile excretion from the body. Understanding the pathophysiology of haemostatic changes in patients with cholestasis, and, more generally, liver disease, is the hallmark of accurate diagnosis and treatment. Jaundice becomes visible when the bilirubin level is about 2 to 3 mgdl 34 to 51 micromoll. The depressed cardiovascular effects of obstructive jaundice are worth noticing because it has complicated mechanisms and needs to be further explored. Study the various causes and sites of obstruction of the biliary tree. More detailed information about the symptoms, causes, and treatments of obstructive jaundice is available below. Jaundice is a condition that causes skin and the whites of the eyes to turn yellow. Pdf background jaundice is a frequent manifestation of biliary tract disorders and evaluation of obstructive. Pathophysiology caused by obstructive jaundice involving coagulopathies, infection, renal dysfunction, and other adverse events should be fully assessed and reversed preoperatively. You may also want to read about gallstones and jaundice for more information aetiology of obstructive jaundice common. Etiological spectrum of obstructive jaundice in a tertiary. Painful obstructive jaundice is often associated with gallstone disease. Jaundice is a manifestation of elevated serum bilirubin, and can have many causes, some of which can be lifethreatening, and can be caused by various factors.
Jaundice usually occurs because of an underlying condition with the liver that means it. The causes of the obstructive jaundice are shown in table 1. Obstructive jaundice is the type of jaundice resulting from obstruction of bile flow to the duodenum from the biliary tract. This may be evidenced by darkcolored urine seen in patients with obstructive jaundice or jaundice due to hepatocellular injury. It can be characterized into three different categories including prehepatic. Jaundice is a symptom of an underlying condition that impairs the excretion of bilirubin from the body. See classification and causes of jaundice or asymptomatic hyperbilirubinemia. Obstructive jaundice caused by tuberculosis is a rare disorder which can mimic other noninfectious causes and can be overlooked due to low incidence. Surgical causes of jaundice inneonates are biliary atresia, inspissated bile syndrome, intrahepatic hypoplasia, choledochalcyst, carolis disease and spontaneous perforation of the bile duct.
This was recognised by whipple in 1935 who recommended an initial cholecystogastrostomy to relieve jaundice prior to a pancreatic resection. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. Specific problems may result from obstructive jaundice complicating pancreatic disease, and this is reflected in a higher mortality when surgery is performed in the presence of jaundice. Obstructive jaundice article about obstructive jaundice.
Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. The most common causes are gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas. Evaluation of jaundice in adults american academy of. Extrahepatic obstructive jaundice is an indication for surgical treatment, except perhaps in cases of sclerosing cholangitis.
As the 120day lifespan of a red blood cell comes to an end or the cell becomes damaged, the cell membrane becomes weak and susceptible to rupture. Presentation of jaundice pathophysiology of jaundice pre hepatic o increased breakdown of red cells leads to increased serum bilirubin. Etiological spectrum of obstructive jaundice in a tertiary care hospital. Investigation and management of obstructive jaundice c d briggs m peterson abstract obstructive jaundice is a medical emergency. Astone or wormin the common bile duct, extrinsic or intrinsic carcinoma blocking the bile duct, or fibrous tissue compressing or strangling the main bile duct or some of its tributaries will all lead to jaundice of the obstructive type. The second type, hepatocellular jaundice, arises when liver cells are damaged so severely that their ability to transport bilirubin diglucoronide into the biliary system is reduced, allowing some of the yellow pigment to regurgitate into the bloodstream. Predominantly conjugated prolonged jaundice conjugated sbr greater than 30 micromoll. Investigation and management of obstructive jaundice. Jaundice is the yellowing of the skin and sclera due to abnormally elevated levels of bilirubin in the blood. The key event in the pathophysiology of obstructive jaundice associated complications is endotoxemia of gut origin because of intestinal barrier failure. Based on pathophysiology jaundice can be obstructive jaundice prehepatic jaundice hepatocellular jaundice 5. Haemostasis impairment in patients with obstructive jaundice. Notably, intravenous feedings predispose patients to bile stasis and a clinical picture of obstructive jaundice. Etiology and epidemiology of obstructive jaundice in.
The full text of this article is available as a pdf 650k. Pathophysiology of increased intestinal permeability in. The common causes of obstructive jaundice were biliary stones 61. Full text get a printable copy pdf file of the complete article 5. A total of 150 patients with obstructive jaundice were examined using ultrasound machine, 3. This unconjugated bilirubin isnt watersoluble so cant be excreted in the urine. Pathophysiology of obstructive jaundice springerlink.
Pathophysiology obstructive jaundice free download as word doc. However, reagent strips are very sensitive to bilirubin, detecting. Systemic effects immunity increased bacterial translocation from the gut in the setting of bile duct obstruction wound healing delayed wound healing and a high incidence of wound dehiscence and incisional hernia have been observed in patients undergoing surgery to relieve obstructive jaundice. In the intestine, deconjugation of the bilirubin by intestinal bacteria occurs and it is again reabsorbed into. Obstructive jaundice often produces pruritus, pale stools, and dark colored urine. This helps in fat emulsification and in the absorption of fat soluble vitamins such as vitamins a, d, e and k.
Specific problems may result from obstructive jaundice complicating pancreatic disease, and this is reflected in a higher mortality when surgery is performed. Hamza introduction neonatal cholestasis is defined as prolonged elevation of serum levels of conjugated bilirubin beyond the first 14 days of life. Obstructive jaundice may be due to a number of causes, all of which narrow or block the bile ducts in some way. Posthepatic, or obstructive jaundice, happens when bilirubin cant be drained properly into the bile ducts or digestive tract because of a blockage.
Simple pathophysiology of obstructive jaundice secondary to choledocholithiasis. Conjugated bilirubin is excreted through the biliary tract to the gut. Obstructive jaundice symptoms, diagnosis, treatments and. Conjunctival icterus is generally a more sensitive sign of hyperbilirubinemia than generalized jaundice. Obstructive jaundice obstructive jaundice whipple s operation anesthetic management munisha agarwal professor deptt. Pathophysiology obstructive jaundice bile exocrine.
632 949 1276 1489 1041 415 517 13 176 1371 79 1484 117 434 291 1024 860 289 1385 1110 169 970 585 647 1345 466 138 679 376 676 1006 1217 304 782