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Obstructive Jaundice

Overview

Jaundice refers to the yellow discoloration of the skin and eyes due to elevated levels of bilirubin in the blood.

  • Bilirubin: A chemical produced by the breakdown of red blood cells, processed by the liver, and excreted via bile.
  • Normal Bile Flow: Bile flows from the liver through bile ducts to the intestines, where it aids in digestion. Any disruption in this process can lead to jaundice.

Obstructive jaundice occurs when the normal flow of bile from the liver to the intestine is blocked. This leads to a buildup of bilirubin in the bloodstream, resulting in yellowing of the skin and eyes, dark urine, pale stools, and itching.

  • Medical Jaundice: Caused by liver dysfunction or systemic illnesses.
  • Surgical/Obstructive Jaundice: Caused by physical blockages in the bile ducts.

  • Medical Causes
    • Infections: Viral hepatitis (A, B, C, non A- non B, E)
    • Liver damage from medications, chemicals and drugs
    • Chronic liver diseases: Conditions like cirrhosis, primary biliary cholangitis, primary sclerosing cholangitis, or autoimmune hepatitis
    • Non-alcoholic fatty liver disease (NAFLD): Common in obese individuals or those with diabetes, leading to cirrhosis.
  • Surgical/Obstructive Causes of Jaundice
    • Gallstones: Stones that migrate to the bile ducts, causing blockage.
    • Tumours: Cancers of the liver, gallbladder, bile duct (cholangiocarcinoma), pancreas, or periampullary region.
    • Biliary Strictures: Narrowing of bile ducts due to scarring or inflammation.

  • Yellowing of the skin and eyes.
  • Dark urine and pale stools.
  • Itching due to bile salts in the skin.
  • Abdominal pain, nausea, or vomiting (depending on the cause).
  • Unexplained weight loss or loss of appetite (especially in cancer-related cases).

  • Blood Tests
    • Liver Function Tests (LFTs): Assess bilirubin levels and liver enzymes.
    • Other Blood Tests: To check for infections, blood counts, or tumor markers.
  • Imaging Studies
    • Ultrasound: Often the first test to identify obstructions or stones.
    • CT Scan/MRI/MRCP: Provide detailed images of the liver, bile ducts, and surrounding structures.
  • Endoscopy
    • Endoscopic Retrograde Cholangiopancreatography (ERCP): Visualizes and treats blockages, obtains tissue samples, and places stents to relieve jaundice.
    • Endoscopic Ultrasound (EUS): Helps in evaluating tumors or stones.

Medical Causes

  • Infections: Treated with antiviral or antibacterial medications.
  • Cirrhosis or NAFLD: Managed through lifestyle changes, medications, or, in severe cases, liver transplantation.

Surgical/Obstructive Causes

  • Gallstones
    • Cholecystectomy: Removal of the gallbladder, often performed laparoscopically.
  • Cancer or Tumours
    • Liver Resection: Removal of part of the liver for liver cancer or metastases.
    • Hilar Resection: Surgery to remove tumours blocking the main bile duct (hilar cholangiocarcinoma).
    • Whipple Procedure: Extensive surgery for cancers of the pancreas, bile ducts, or periampullary region.
  • Minimally Invasive Procedures
    • ERCP with Stenting: Temporary relief of jaundice by placing plastic or metal stents in bile ducts.
    • Stone Removal: Endoscopic extraction of stones blocking bile flow.
  • Advanced Cancer

Palliative Care

Focuses on symptom relief, including biliary drainage to improve quality of life.

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