Physiologybiochemistry of bilirubin production and transport. Obstructive jaundice can be dangerous, if not treated at an early stage. In the intestine, deconjugation of the bilirubin by intestinal bacteria occurs and it is again reabsorbed into. All patients enrolled in this study were diagnosed as having inoperable malignant obstructive jaundice based on clinical symptoms jaundice, darkcolored urine, and pale stool, laboratory examinations elevated bilirubin levels, alkaline phosphatase levels, and gamma glutamyl transferase levels, and imaging examinations including transabdominal ultrasound, computed tomography ct scan of. Oct 16, 2019 biliary obstruction associated with pancreatitis is observed most commonly in patients with dilated pancreatic ducts due to either inflammation with fibrosis of the pancreas or a pseudocyst. Obstructive jaundice is commonly caused by gallstones large duct obstruction or a cancer of the head of the pancreas, or by disease processes that occlude the small bile ducts within the liver, such as hepatitis and cirrhosis small duct obstruction. Obstructive jaundice pancreatic cancer liver scribd. This helps in fat emulsification and in the absorption of fat soluble vitamins such as vitamins a, d, e and k. Scribd is the worlds largest social reading and publishing site. Pathophysiology obstructive jaundice bile exocrine. Clinical and regulatory protocol for the treatment of. Obstructive jaundice causes, symptoms, pathophysiology.
Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia. Neonatal jaundice physiologic jaundice nonpathologic unconjugated hyperbilirubinemia. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Hospital mumbai 400012 2 management of obstructive jaundice 3 is there a jaundice. Jaundice becomes visible when the bilirubin level is about 2 to 3 mgdl 34 to 51 micromoll. Jaundice is a symptom of an underlying condition that impairs the excretion of bilirubin from the body. Obstructive jaundice free download as powerpoint presentation. Jaundice is not usually apparent until serum bilirubin is over 35.
In all babies with prolonged jaundice, blood should be taken for total and conjugated bilirubin level. Understanding the pathophysiology of haemostatic changes in patients with cholestasis, and, more generally, liver disease, is the hallmark of accurate diagnosis and treatment. Mar 09, 20 obstructive jaundice is a condition in which thereis blockage of the flow of bile out of the liver. This is a basic article for medical students and other nonradiologists. Pathophysiology the classic definition of jaundice is a serum bilirubin level greater than 2. Thisresults in an overflow of bile and its byproductsinto the blood, and bile excretion from. Management of obsructive jaundice by mohd taofiq authorstream. Based on pathophysiology jaundice can be obstructive jaundice prehepatic jaundice hepatocellular jaundice 5. I am discussing about the various causes of obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose the various causes for. In this article, suzanne sargent and michelle clayton provide an overview of the pathophysiology of the formation and metabolism of bilirubin and examines the most common causes of jaundice in the adult patient. See also liver structure and function and evaluation of the patient with a liver disorder. Oct 16, 2019 zhu y, wang s, zhao s, qi l, li z, bai y. Jaundice develops due to increase the level of bilirubin and deposition under the skin and cause the yellow discoloration of the skin.
Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Choledocholithiasis pathophysiology free download as pdf file. The causes of obstructive jaundice included gall stones in 20 40% patients, mass head of pancreas in 16 32%, and biliary strictures in 4 8% cases while hepatic abscesses, pseudopancreatic. We must therefore conclude that after biliary obstruction bile enters the circulation both by way of the blood capillaries. This was recognised by whipple in 1935 who recommended an initial cholecystogastrostomy to relieve jaundice prior to a pancreatic resection. Obstructive jaundice article about obstructive jaundice. As the 120day lifespan of a red blood cell comes to an end or the cell becomes damaged, the. Haemostasis impairment in patients with obstructive jaundice. Obstructive jaundice and perioperative management request pdf.
However not all obstructive jaundice is surgical jaundice and not all surgical jaundice is due to obstruction. Biliary obstruction associated with pancreatitis is observed most commonly in patients with dilated pancreatic ducts due to either inflammation with fibrosis of the pancreas or a pseudocyst. Other complications of gallstones such as gastric outlet obstruction, or gallstone ileus and other conditions related to the gallbladder such as gallbladder cancer, or biliary dyskinesia are not included in this guideline. Pathophysiology of obstructive jaundice and its surgical problems. Systemic effects immunity increased bacterial translocation from the gut in the setting of bile duct obstruction wound healing delayed wound healing and a high incidence of wound dehiscence and incisional hernia have been observed in patients undergoing surgery to relieve obstructive jaundice 11. Jaundice hepatic and biliary disorders merck manuals. It produces around one liter of bile everyday, that helps in the digestion of. Here the practitioner must often rely on the history. Ppt case presentation obstructive jaundice powerpoint. Disorders of the biliary tract affect a significant portion of the worldwide population, and the overwhelming majority of cases are attributable to cholelithiasis gallstones. Jaundice is obstructive in nature as a result of cholelithiasis. Obstructive jaundice definition of obstructive jaundice by. Of nursing a case study about obstructive jaundice secondary to.
Obstructive jaundice and perioperative management sciencedirect. Investigation and management of obstructive jaundice. Unlimited access to the largest elibrary of professional videos, images, documents, courses. It is the yellowish discolouration of the skin, the conjunctiva and other mucous membranes caused by hyperbilirubinemia 35. The detection and differential diagnosis of jaundice are important in clinical assessment. Hardikar 1 approach to a case of obstructive jaundice dr.
Obstructive jaundice summary radiology reference article. In early obstructive jaundice bile first appears in the lymph, but exclusion of the thoracic duct from the circulation by drainage causes a delay of only a few hours in the appearance of bile bilirubin in the blood stream. The treatment of jaundice in adults and elderly subjects is amongst the themes selected for elaborating the crps since jaundice is a medical sign frequently seen in four clinical scenarios involving distinctive diagnostic and therapeutic interventions which. It contains of cholesterol,bilirubin,bile acid and lethicin which aids in emulsifies fat. Obstructive jaundice often produces pruritus, pale stools, and dark colored urine. Notably, intravenous feedings predispose patients to bile stasis and a clinical picture of obstructive jaundice. Obstructive jaundice oj is the partial or total blockage of the extra or intrahepatic biliary ducts that leads to a corruption of the normal biliary passage to the intestines.
Presentation of jaundice pathophysiology of jaundice. Rle case study obstructive jaundice free download as word doc. Differential diagnosis of obstructive jaundice springerlink. Obstructive jaundice is a fairly common presentation to the emergency department and surgical teams. Jaundice overview free download as powerpoint presentation. Pathophysiology of obstructive jaundice springerlink.
Obstructive jaundice is a condition in which thereis blockage of the flow of bile out of the liver. Jaundice in babies occurs in over half in the first week following birth and does not pose a serious threat in most. Pathophysiology of obstructive jaundice and its surgical. Rle case study obstructive jaundice gallbladder bile scribd. The following article provides information about this condition, its symptoms, causes, diagnosis, and various treatment options available. Pathogenesis of neonatal jaundice includes physiologic process of bilirubin accumulation or pathological mechanism. Simple pathophysiology of obstructive jaundice secondary to choledocholithiasis. Common bile duct stones, including biliary colic, cholangitis, obstructive jaundice and gallstone pancreatitis. This unconjugated bilirubin isnt watersoluble so cant be excreted in the urine. Main causes of obstructive jaundice bile duct in the lumen of the common bile duct gallstones, parasites in the wall of the duct choledochal cyst, sclerosing cholangigis, cholangiocarcinoma pressing in on the bile duct mirrizi, pancreatitis, pancreatic cancer, malignant nodes ampulla periampullary carcinoma tumor invading the ampulla. Jaundice not usually apparent until serum bilirubin 35 moll. Effects of obstructive jaundice on various systems changes in liver blood flow acute obstruction increase in hepatic arterial blood flow no change in portal venous blood flow chronic obstruction decrease in total liver blood flow, dilatation of sinusoids and elevation of. The need for radiological imaging in obstructive jaundice are.
Mitochondrial respiratory function, ketogenesis, collagen metabolism of the liver in rats, dogs and patients with obstructive jaundice were investigated. Total serum bilirubin peaks at age 35 d later in asian infants. Key words obstructive jaundice hepatocellular carcinoma. Majority are due to extrahepatic biliary obstruction obstructive jaundice.
Jul 23, 2016 i am discussing about the various causes of obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose the various causes for. Conjugated bilirubin is excreted through the biliary tract to the gut. Presence of pale stools and dark urine is suggestive of obstructive jaundice. The depressed cardiovascular effects of obstructive jaundice are worth noticing because it has complicated mechanisms and needs to be further explored. Obstructive jaundice definition of obstructive jaundice. Abdominal pain along with fevers and jaundice is suggestive of obstruction with an associated infection known as cholangitis. Jaundice secondary to choledocholithiasis free download as. Obstructive jaundice is either caused by damaged hepatocytes hepatitis or due to the blockade in the bile ducts gallstones or due to cancer in the head of the pancreas strongly associated with smoking, diabetes mellitus, men syndrome, hnpcc, chronic pancreatitis. In oj, bile acids cause injury via free radicals and create oxidative stress in. Adult jaundicethe pathophysiology, classification and. Investigation and management of obstructive jaundice c d briggs m peterson abstract obstructive jaundice is a medical emergency. Jaundice, also known as icterus, is a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels. Presentation of jaundice pathophysiology of jaundice pre hepatic o increased breakdown of red cells leads to increased serum bilirubin.
Schematic diagram obstructive jaundice free download as word doc. A neoplastic obstruction may produce a confused picture, yet frequently the course is characteristic. You may also want to read about gallstones and jaundice for more information aetiology of. Obstructive jaundice due to a blood clot after ercp. If bilirubin levels in babies are very high for too long. Sep 12, 2012 based on pathophysiology jaundice can be obstructive jaundice prehepatic jaundice hepatocellular jaundice 5. Mean peak total serum bilirubin is 6 mgdl higher in asian infants.
After attempting to evaluate and interpret a number of tests it must be remembered that there is a small group of jaundiced persons in whom diagnosis resists the usual investigative methods. Symptoms of obstructive jaundice include the typical yellowing of jaundice as well as dark urine, pale feces, and itching. You may also want to read about gallstones and jaundice for more information. Definition yellow discolouration caused by accumulation of bilirubin in tissue. Obstructive jaundice secondary to choledocholithiasis scribd. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Jo jh, cho cm, jun jh, et al, for the eus study group of the korean society of gastrointestinal endoscopy.
Pathophysiology caused by obstructive jaundice involving coagulopathies, infection, renal dysfunction, and other adverse events should be fully assessed and reversed preoperatively. Pathophysiology obstructive jaundice free download as word doc. Pathophysiology of obstructive jaundice linkedin slideshare. Management of obsructive jaundice by mohd taofiq authorstream presentation. Feb 08, 2020 obstructive jaundice is a fairly common presentation to the emergency department and surgical teams. Obstructive jaundice is a particular type of jaundice when the essential flow of bile to the intestines was blocked.
The rate of bilirubin formation and conjugation is. The liver plays a very important role in the human body. Jaundice caused by obstruction of the drainage through the bile ducts, as may occur with gallstones. In oj, bile acids cause injury via free radicals and create oxidative stress in extrahepatic tissues. In the united states, 20% of persons older than 65 years have gallstones and 1 million newly diagnosed cases of gallstones are reported each year. Obstructive jaundice article about obstructive jaundice by. An algorithmic approach to the evaluation of jaundice in adults.
A malignant source of obstruction more often presents with painless jaundice and weight loss. Clinical jaundice may not become apparent until serum bilirubin is greater than 51 micromoll. Jaundice icterus is the commonest presentation in patients with liver disease. Jaundice can be caused by a wide variety of disorders which range from benign to lifethreatening conditions, such as gilberts syndrome and pancreatic cancer respectively. Etiological spectrum of obstructive jaundice in a tertiary. Obstructive jaundice represents a set of conditions that cause jaundice by obstructing the flow of bile into the duodenum anywhere along the intrahepatic or extrahepatic biliary tree. Jaundice overview liver diseases and disorders scribd. Dec 23, 2015 jaundice is the yellow discolouration caused by accumulation of bilirubin in tissue. Etiological spectrum of obstructive jaundice in a tertiary care hospital.
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