Obstructive jaundice

Question 1

what is obstructive jaundice also known as

Answer 1

cholestatic jaundice

Question 2

Define obstructive jaundice

Answer 2

when there is a mechanical blockage of bile flow from the liver to the duodenum, leading to the accumulation of conjugated bilirubin in the bloodstream.

Question 3

Clinical features of obstructive jaundice

Answer 3

• Jaundice: Yellow discoloration of the skin and sclera.
• Dark Urine: Due to increased excretion of conjugated bilirubin.
• Pale/Clay-Colored Stools: Due to the absence of stercobilin in the stool.
• Pruritus: Accumulation of bile salts.
• Abdominal Pain: Often in the right upper quadrant (RUQ) or epigastrium.
• Weight Loss and Fat Malabsorption: Due to impaired bile salt secretion.

Question 4

Causes of bbstructive jaundice can be divided into 3 categories

Answer 4

1. Intraluminal causes
2. Mural causes
3. Extrinsic causes

Question 5

Intraluminal Causes of Obstructive Jaundice

Answer 5

• Gallstones (Choledocholithiasis) – Stones in the common bile duct (CBD).
• Mirizzi Syndrome - gallstone becomes impacted in the cystic duct or Hartmann’s pouch of the gallbladder, causing external compression of the common hepatic duct (CHD) or common bile duct (CBD)
• Biliary Sludge – Thickened bile causing partial obstruction.
• Parasites – Ascaris or Clonorchis causing obstruction.

Question 6

Mural Causes of Obstructive Jaundice

Answer 6

• Cholangiocarcinoma – Cancer arising from the bile ducts.
• Biliary Strictures – Benign or malignant strictures narrowing the bile ducts.
• Primary Sclerosing Cholangitis (PSC) – Chronic inflammation and fibrosis of the bile ducts.
• Post-surgical or Post-inflammatory Strictures – After cholecystectomy or bile duct injury.

Question 7

Extrinsic Causes of Obstructive Jaundice

Answer 7

• Pancreatic Cancer – Compression of the distal CBD by the tumor.
• Periampullary Tumor – Tumors at the ampulla of Vater.
  Enlarged Lymph Nodes (e.g., Metastatic Disease) – Compression of the bile ducts.
• Chronic Pancreatitis – Fibrosis causing biliary obstruction.

Question 8

Tx for biliary strictures

Answer 8

ERCP with stenting

Question 9

Obstructive picture of LFTs

Answer 9

• sig. raise of ALP
• slightly raised ALT/AST

Question 10

Hepatic picture of LFTs

Answer 10

• sig. raise of ALT/AST
• slightly raise of ALP

Question 10

what systems are ALP assoc with

Answer 10

• Liver
• Biliary
• Bones
• Placenta (pregnancy)

Question 11

what is AST/ALT assoc. with

Answer 11

Hepatocellular injury (Liver cells damage)