8lllary CbsLrucLlon

8y ur A 1lnnle
lnLroducLlon
W 8lllary obsLrucLlon refers Lo Lhe blockage of
any ducL LhaL carrles blle from Lhe llver Lo Lhe
gallbladder or from Lhe gallbladder Lo Lhe
small lnLesLlne
W may be due Lo mechanlcal means or meLabollc
facLors ln Lhe hepaLlc cells
W physlcal obsLrucLlon causes a predomlnanLly
con[ugaLed hyperblllrublnemla
W !aundlce may noL be cllnlcally recognlzable
unLll levels are aL leasL 3 mg/dL
Causes
W lnLrahepaLlc causes
W PepaLlLls
W Clrrhosls
W urugs( anabollc sLerolds
and CZ)
W LxLra hepaLlc causes
W lnLraducLal
W exLraducLal
W lnLraducLal neoplasms
sLone dlsease blllary
sLrlcLure paraslLes
prlmary scleroslng
cholanglLls (SC) AluS
relaLed cholanglopaLhy
and blllary 18
W LxLraducLal obsLrucLlon
neoplasms pancreaLlLls
or cysLlc ducL sLones
(Mlrlzzl)
Cllnlcal feaLures
W at|ents common|y comp|a|n of pa|e
stoo|s dark ur|ne [aund|ce and
prur|tus
W PlsLory
W 1he followlng conslderaLlons are
lmporLanL
aLlenLs ages and assoclaLed
condlLlons
1he presence or absence of paln
1he locaLlon and characLerlsLlcs
of Lhe paln
1he acuLeness of Lhe sympLoms
1he presence of sysLemlc
sympLoms (eg fever welghL loss)
PlsLory of anemla
revlous mallgnancy
known gallsLone dlsease
CasLrolnLesLlnal bleedlng
PepaLlLls
revlous blllary surgery
ulabeLes or dlarrhea of recenL
onseL
W Also explore Lhe use of alcohol
drugs and medlcaLlons
W 1he cause of lLchlng (prurlLus)
W accumulaLlon of blle aclds ln Lhe skln
W release of endogenous oplolds
Cl
W hyslcal examlnaLlon
W slgns of [aundlce (skln and
lcLerus)
W Lhe gallbladder may be
palpable (Courvolsler slgn)
W look for slgns of welghL loss
adenopaLhles and occulL
blood ln Lhe sLool suggesLlng
a neoplasLlc leslon
W noLe Lhe presence or absence
of asclLes and collaLeral
clrculaLlon assoclaLed wlLh
clrrhosls
W A hlgh fever and chllls suggesL
a coexlsLlng cholanglLls
W aln and Lenderness ?
Mallgnancy ls more commonly
assoclaLed wlLh Lhe absence of
paln and Lenderness durlng
Lhe physlcal examlnaLlon
W xanLhomaLa are assoclaLed
wlLh prlmary blllary clrrhosls
(8C)
W LxcorlaLlons suggesL prolonged
cholesLasls or hlghgrade
blllary obsLrucLlon
lnvesLlgaLlon
W 8lllrubln
W 1ransamlnases (AS1
/AL1)
W Alk phosp
W CC1
W 1
W Ax8
W AuS
W C1
W M8l
W L8C
W 1C
W LuS
lnvesLlgaLlon
W urlne blllrubln (deLecLlng as llLLle as 003
mg/dL) may be found before serum blllrubln
reaches levels hlgh enough Lo cause cllnlcal
[aundlce
1reaLmenL
W 1reaL Lhe underlylng cause!
W Medlcal
W ursodeoxychollc acld (10 mg/kg/d) (3040)
W 8lle acldblndlng reslns cholesLyramlne (4 g)
or colesLlpol (3 g)(prurlLus)
W AnLlhlsLamlnes
W naloxone ?
W vlLamln k
1reaLmenL
Surgery
W CholecysLecLomy +/_ C8u exploraLlon
W 8esecLablllLy of neoplasLlc causes depends on
sLage aL presenLaLlon
Lnu