Click here to load reader
Upload
hatem-el-gohary
View
332
Download
3
Embed Size (px)
Citation preview
OBSTRUCTIVE JAUNDICE
Dr Hatem EL Gohary
Lecturer of General Surgery
Definition of jaundice
Yellowish discoloration of sclera and skin due to high levels of bilirubin which is manifested above 2 mg/dl.
Physiology of Bilirubin
CausesCalcular: Gall bladder stones passing
through cystic duct to obstruct the common bile duct.
Malignant: - Cancer head of the Pancreas. - Cholangiocarcinoma.
Clinical Picture Jaundice (sclera – Palate) ItchingPain (Cholangitis) Fever (Cholangitis)Dark urine Pale stool.
Investigations
Laboratory: -Total bilirubin and Direct bilirubin(Conjugated) Direct bilirubin more elevated than indirect. - Liver Enzymes elevated. - Hepatitis Markers (A, B & C). - Coagulation Profile (Prothrombin time).
Radiological:-Ultrasound Abdomen showing dilated CBD + stones.- CT and MRI Abdomen showing pancreatic tumor and liver metastasis.- ERCP (Endoscopic retrograde cholangio- pancreatography) diagnostic and therapeutic.
Treatment General: IV fluids – Urine output chart –
Vitamin K –Broad spectrum Antibiotics.
Calcular:- Removal of CBD stones either by ERCP or By Surgical CBD Exploration + Cholecystectomy.
Malignant: Whipple’s Operation.