JAUNDICE

SYMPTOMS

◆ Yellow skin and sclera

◆ Pale Stools

◆ Dark Urine

◆ +/- Pruritus

+ Dilated ducts on US = Obstructive Jaundice (> 8mm)

+ Non dilated ducts on US = Cholestasis, Hepatic, Haemolytic?
 JAUNDICE
PRE HEPATIC
Haemolytic anaemias
Gilberts Disease ↑Unconjugated Bilirubin

HEPATIC
Acute
Chronic

POST HEPATIC
Obstruction

UROBILINOGEN STERCOBILINOGEN UROBILINOGEN

 JAUNDICE

SIGNS
◆Hands: Spider Naevi, palmar erythema, dupoytren’s
contracture, clubbing
◆Eyes: Yellow sclera
◆Chest: Gynaecomastia
◆Abdomen: Ascites, hepatomegaly, splenomegaly
◆Lower Limbs: Peripheral oedema
 OBSTRUCTIVE JAUNDICE

Etiology
◆ Benign Stones
Stricture Iatrogenic
Mirizzi’s
PSC
Chronic Pancreatitis

◆ Malignant Periampullary Pancreas

Duodenal
Ampullary
Cholangiocarcinoma
Cholangiocarcinoma
Hilar Lymphadenectomy
OBSTRUCTIVE JAUNDICE
 JAUNDICE

RISK FACTORS

● Blood Transfusions
● Previous Hepatitis
● Intravenous Drug Abuse
● Medications
● Alcohol Abuse
● Family History
● Previous Biliary Surgery (stones, stricture)
● Systemic Symptoms
OBSTRUCTIVE JAUNDICE
Pale Stools, Dark Urine, +/- Pruritus

URINE BILIRUBIN +, UROBILINOGEN –

BLOOD ↑ ALK PHOS, ↑ YGT

RADIOLOGY US DILATED DUCTS

Augmentin
 OBSTRUCTIVE JAUNDICE
? CAUSE

• US Extent of duct dilatation

? Mass +/- Biopsy

• CT Location of mass +/- Biopsy

? Metastases

Cholangiogram MRCP Dx
ERCP Dx + Tx
PTC Dx + Tx
 TREATMENT OF
OBSTRUCTIVE JAUNDICE
STONES

● Endoscopic - removal (+/- sphincterotomy)

- stent

● Laparoscopic Bile Duct Exploration

● Open bile duct exploration (+/- T Tube)

 TREATMENT OF
OBSTRUCTIVE JAUNDICE
BENIGN STRICTURES

1. Stent ERCP | PTC

Plastic | Metal

2. Operative Roux-en-Y hepaticojejunostomy

 TREATMENT OF
OBSTRUCTIVE JAUNDICE
TUMOURS
• Resect IF Locally confirmed
No metastases
Good general condition

• Palliate Bypass (operative)

• Stent ERCP, PTC
 Gallstones

Predictors of CBD Stones

◆Jaundice
◆Cholangitis
◆Pancreatitis
◆LFTS
◆Dilated CBD on US
 Gallstones

Management of CBD Stones

1. Clear CBD - ERCP
- Surgery Laparoscopic
Open
2. Stent CBD (Elderly)