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Cholestatic Jaundice

Obstructive Jaundice


Presentation

  • If duodenal diverticula are frequently asymptomatic, they can occasionally present with obstructive jaundice in the absence of lithiasis or another obstructing lesion such as a tumor in a presentation called Lemmel's syndrome.[ncbi.nlm.nih.gov]
Fatigue
  • […] symptoms of jaundice include : a yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body pale stools dark urine itchiness Accompanying symptoms of jaundice resulting from low bilirubin levels include: fatigue[medicalnewstoday.com]
Soft Tissue Mass
  • Hepaticojejunostomy was performed and pathologic analysis of the conglomerated soft-tissue mass revealed chronic granulomatous inflammation with caseation of the lymph nodes.[ncbi.nlm.nih.gov]
Steatorrhea
  • Some of these effects include : Steatorrhea (‘fatty stools’) Unintentional weight loss Softening of the bones (osteomalacia) Bleeding disorders Muscle pain and weakness Abnormal sensations like numbness and tingling Other late features of obstructive[healthhype.com]
  • Liver biopsy CT Ultrasound MRI Doppler flow Endoscopic cholangiography PTC ( percutaneous transhepatic cholangiography) ERCP (endoscopic retrograde cholangiopancretography) /cytology/biopsy Chronic bile stasis Pruritus - bile salts Steatorrhea - malabsorption[meddean.luc.edu]
  • Vitamin A supplements prevent deficiency and severe steatorrhea can be minimized by replacing some dietary fat with medium-chain triglycerides.[ptolemy.ca]
  • . • Failure of bile salts to reach the intestine results in fat malabsorption with steatorrhea.[slideshare.net]
Clay-Colored Stool
  • Clay colored stool, weight loss and palpable abdominal mass were more common in malignant obstructive jaundice, whereas right upper abdominal pain was more common in benign obstructive jaundice.[bmcresnotes.biomedcentral.com]
  • Regarding the symptoms, clinical jaundice was most common, seen in 97 (88%) patients followed by right upper quadrant pain in 75(66.2%) patients, dark urine in 64 (55.2%), pruritius in 60 (54.5%), clay colored stools in 54(49.1%), weight loss in 48( 43.6%[ispub.com]
Vascular Disease
  • Visceral arterial aneurysm and pseudoaneurysm are uncommon forms of vascular disease that have a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage.[ncbi.nlm.nih.gov]
Jaundice
  • Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined.[ncbi.nlm.nih.gov]
Hepatomegaly
  • Abdominal Pain Gallstones – stones are in the common bile duct Choledochal cysts (congenital anomalies of the bile duct) Pancreatitis Fever with Abdominal Pain Gallstones Choledochal cyst Stricture Abdominal Mass Pancreatitis Choledochal cyst Liver cancer Hepatomegaly[healthhype.com]
  • Abdominal examination showed a tender hepatomegaly 3 cm below the costal margin with a smooth surface. There was no shifting dullness. Investigations revealed conjugated hyperbilirubinaemia with total bilirubin 10 mg% and direct 4.2 mg%.[termedia.pl]
  • The examination findings revealed that 24 (21.8%) patients had hepatomegaly, 20(18.2%) had palpable gallbladder.[ispub.com]
  • On examination, hepatomegaly, signs ofadvanced disease and cirrhosis, such as ascites, umbilicalhernia, prominent abdominal veins and respiratory discomfortmay be present.[tropicalgastro.com]
Scleral Icterus
  • […] carotenemia. carotenemia does not cause scleral icterus Hyperbilirubinemia per se has no patho-physiologic effect.[meddean.luc.edu]
Pruritus
  • Theses elevated endogenous opioids bring complications like pruritus, cardiac and vascular abnormalities in patients with cholestasis.[ncbi.nlm.nih.gov]
  • Evidence of skin scratching as a response to pruritus should be noted. Investigations Liver function tests A ward test of the urine in obstructive jaundice will demonstrate the presence of bilirubin and the absence of urobilinogen.[surgwiki.com]
  • There was no history of haematemesis, malena, pruritus or clay-coloured stools, no haemoptysis or breathlessness. There was no past history of jaundice, blood transfusion, surgical interventions or treatment for pulmonary tuberculosis.[termedia.pl]
  • High levels of circulating bile salts are associated with, but may not cause, pruritus.[ptolemy.ca]
  • . • The cause of itching (pruritus) associated with biliary obstruction is not clear. Some believe it may be related to the accumulation of bile acids in the skin. Others suggest it may be related to the release of endogenous opioids. 12.[slideshare.net]
Excoriation
  • . • Excoriations suggest prolonged cholestasis or high-grade biliary obstruction 23.[slideshare.net]
  • Excoriations suggest prolonged cholestasis or high-grade biliary obstruction. Center SA. Diseases of the gallbladder and biliary tree. Vet Clin North Am Small Anim Pract. 2009 May. 39(3):543-98. [Medline]. Marrelli D, Caruso S, Pedrazzani C, et al.[emedicine.medscape.com]
Dark Urine
  • Symptoms of obstructive jaundice include the typical yellowing of jaundice as well as dark urine, pale feces, and itching . Also known as post-hepatic jaundice.[medicinenet.com]
  • Symptoms & Effects of obstructive jaundice may include: Dark Urine Pale Faeces Itching Compare obstructive jaundice with hepatocellular jaundice and haemolytic jaundice. Click for pages about Digestion[ivyroses.com]
  • Patients with medical jaundice will have yellowing of the skin, without dark urine or light-coloured stools.[healthxchange.sg]
  • ‘Two thirds of pancreatic cancers develop in the head of the pancreas, and most patients present with progressive, obstructive jaundice with dark urine and pale stools.’[oxforddictionaries.com]

Workup

  • Further radiological workup including CT (model GE CT/e ), MRCP (model GE Signa HDe 1.5T ) and ERCP or PTC was done as per the protocol as indicated mentioned in flow chart below.[ispub.com]

Treatment

  • However, effective biliary drainage and treatment of HCC such as with TACE or radiotherapy improves survival.[ncbi.nlm.nih.gov]

Prognosis

  • OBJECTIVE: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma.[ncbi.nlm.nih.gov]
  • Furthermore, the prognosis of the patients was analyzed.[journalofhospitalmedicine.com]

Etiology

  • Once these abnormalities are identified, more extensive imaging tests can be performed to determine the nature, etiology, and level of obstruction. This information is essential for clinicians as they decide on management and treatment strategies.[ncbi.nlm.nih.gov]
  • No other major age differences were observed in the etiological groups.[journalofhospitalmedicine.com]
  • These observations reflect differences in etiological spectrum from one centre to another.[bmcresnotes.biomedcentral.com]

Epidemiology

  • Outline of Discussion • Definition • Epidemiology • Classification • Pathophysiology • Clinical evaluation • Management 3.[slideshare.net]
  • Epidemiological characteristics of the colorectal carcinoma on the territory of the municipality of Cacak. Acta Medica Medianae 2002; 41(3):29-36.[cyberleninka.org]
  • Epidemiology United States data The incidence of biliary obstruction is approximately 5 cases per 1000 people. Race-related demographics The racial predilection depends on the cause of the biliary obstruction.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This clinical review considers the pathophysiology, investigation and management of patients with obstructive jaundice and considers the particular challenges that medical personnel may face when deployed away from the United Kingdom (UK).[ncbi.nlm.nih.gov]
  • Pathophysiology of obstructivejaundice 18. PATHOPHYSIOLOGY OFOBSTRUCTIVE JAUNDICEObstructive jaundice is a condition in which there is blockage of the flow of bileout of the liver.[slideshare.net]
  • The commonest complications are related to sepsis but the pathophysiological mechanisms behind this susceptibility to bacterial infection are not clear.[clinicaltrials.gov]

Prevention

  • Third, the patient has cirrhosis, preventing dilation of the ducts (the extrahepatic ducts, however, will still dilate if the obstruction is outside the liver).[surgwiki.com]
  • To prevent jaundice resulting from gallstone disease, eat a healthy, balanced diet and reduce your intake of fatty foods and alcohol. Ref: P16[healthxchange.sg]
  • Obstructive jaundice is a specific type of jaundice, where symptoms develop due to a narrowed or blocked bile duct or pancreatic duct, preventing the normal drainage of bile from the bloodstream into the intestines.[nyp.org]
  • Primary sclerosing cholangitis Primary biliary cirrhosis Causes of Cholestatic Jaundice (Obstructive) Gallstones Stones lodged in the common bile duct (choledocholithiasis) prevents the flow of bile.[healthhype.com]

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