Obstructive Jaundice

Obstructive jaundice is a common surgical pathology characterized by classic symptoms such as dark urine, pale stools, itching, and nausea/vomiting. It is not associated with rashes. Causes include gallstones and extrahepatic cholangiocarcinoma. Clinically jaundiced patients have bilirubin levels of 70 micromoles per liter or higher.

Obstructive jaundice is caused by narrowing or blockage of the biliary drainage system, preventing bilirubin from entering the intestine and causing a backup.

Obstructive jaundice is caused by factors such as cholelithiasis (gallstones), cholangiocarcinoma, carcinoma of the pancreatic head, biliary strictures, iatrogenic causes, and other conditions like PVC and PSC.

Obstructive Jaundice Symptoms Symptoms of defects such as biliary atresia, Kola docks or cysts pancreatitis and one of the common symptoms that people present with is obstructive jaundice. The classic signs are dark urine, pale stools, yellow discoloration of the skin and sclera, nausea and vomiting.

Associated Pain Right upper quadrant pain or epigastric abdominal pain per itis which is itchy skin and anorexia which could be weight loss.

Diagnosing Obstructive Jaundice Obstructive jaundice can be caused by gallstones or cholangiocarcinoma, with different histories and symptoms. Detailed history-taking is crucial to identify associated signs like pain, nausea, vomiting, fever, and the nature of jaundice. Examination includes palpating the gall bladder for tenderness and checking for systemic effects through observations such as blood pressure and pulse oximetry.

Investigations for Obstructive Jaundice Standard investigations include full set of observations (BP, pulse oximetry), urinalysis to rule out urinary problems; FBC looking at white cell count & CRP; liver function tests including hepatitis antibodies & HIV screening. Abdominal ultrasound is the gold standard diagnostic test to rule out gallstones or other abnormalities in the biliary system. MRCP & ERCP are endoscopic options used for diagnosis and treatment if indicated based on patient's history or previous findings.

The differential diagnosis includes pre-hepatic jaundice, hepatic jaundice, hemolytic anemia, thalassemia, viral hepatitis, intrahepatic cholestasis, and cirrhosis due to long-standing liver disease.

Surgical Options for Gallstones The gold standard treatment for gallstones is laparoscopic cholecystectomy, which involves making three incisions in the abdomen and removing the gallbladder. However, some patients may not be eligible due to medical history or fibrosis around the gallbladder, leading to open prostatectomy or Whipple procedure.

Whipple Procedure for Pancreatic Carcinoma The Whipple procedure is used for patients with carcinoma in the pancreatic head. It involves removing part of the bile duct, duodenum, and pancreatic head; then reattaching the bile duct onto jejunum and connecting jejunum to pancreas.

Full abdominal examination is necessary for patients with obstructive jaundice. Look for signs of clubbing, palmar erythema, and Dupuytren's contracture.

Tips for abdominal exams in OSCEs: Get down to the patient's level during palpation, keep looking at their face when eliciting tenderness, and use Murphy sign. Palpate the right upper quadrant by pushing down firmly while the patient takes a deep breath to check for gallbladder issues. Look out for scars on the abdomen as they could indicate previous problems.

Obstructive jaundice can be caused by various conditions, but cirrhosis is not one of them. The anatomical portions of the pancreas are the head, tail, and body. The most common incision used for an open cholecystectomy is Kocher's incision.