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]

• Weight Loss

  A 33-year-old man presented with jaundice, mild pancreatitis, and some weight loss. Laboratory tests showed cholestatic icterus. Imaging revealed distal bile duct obstruction and a mass in the head of the pancreas suspicious for cancer. [ncbi.nlm.nih.gov]

  ‘The patient was a 74-year-old man admitted to the hospital with complaints of progressive obstructive jaundice and a 5-kg weight loss.’ ‘A 66-year-old man had a laparotomy for obstructive jaundice due to a malignant mass.’ [en.oxforddictionaries.com]

• Ascites

  A new equation was developed to assess risk: R = 7 × (duration of biliary obstruction-0 if < 30 d, 1 if > 30 d) + 7 × (CA19-9-0 if < 500, 1 if > 500) + 7 × (ascites-0 if none present, 1 if ascites present) + 10 × (lymph node metastasis-0 if no metastasis [ncbi.nlm.nih.gov]

  Then suddenly the picture of a rapidly progressive intoxication is superimposed on the silent jaundice; ascites, coma and spontaneous hemorrhages may supervene, and death quickly follows. [jamanetwork.com]

  Examination revealed hepatomegaly and ascites. Laboratory investigations revealed hyperbilirubinemia with cholestasis. [elsevier.es]

  Abdominal ultrasound demonstrated increase echogenicity of the liver and revealed trace abdominal and pelvic ascites. [onlinelibrary.wiley.com]

• Fatigue

  Fatigue: About 70% to 80% patients with chronic fatigue suffer from fatigue. Underlying abnormal serotonergic neurotransmission or neuroendocrine defects in the corticotrophin hormone axis are believed to be underlying etiology. [ncbi.nlm.nih.gov]

• Malaise

  Patients with acute DILI who are symptomatic may report malaise, low-grade fever, anorexia, nausea, vomiting, right upper quadrant pain, jaundice, acholic stools, or dark urine. [hindawi.com]

  In GH, non-specific symptoms are the rule, usually including malaise, anorexia, and fever. Manifestat ions of profound cholestasis or hepatic failure are rare[77]. [ncbi.nlm.nih.gov]

• Congestive Heart Failure

  Tender hepatomegaly can be seen in viral hepatitis, congestive heart failure, and alcoholic hepatitis. In choledocholithiasis and cholecystitis, right upper quadrant (RUQ) tenderness is appreciated. [ncbi.nlm.nih.gov]

• Abdominal Pain

  Thus, although relatively rare, pancreatic SCA is one of the differential diagnoses of epigastric abdominal pain; we recommend early surgical intervention for symptomatic pancreatic SCA. [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]

  References:[10][8] Clinical features In addition to jaundice, the following signs may also indicate cholestasis: Pale, clay-colored (acholic) stool Darkening of urine Pruritus Fat malabsorption (steatorrhea, weight loss) References:[10][8][11][12] Diagnostics [amboss.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]

  Stools may contain too much fat (a condition called steatorrhea) because bile cannot enter the intestine to help digest fat in foods. Fatty stools may be foul-smelling. [msdmanuals.com]

• Right Upper Quadrant Pain

  A 57-year-old male patient presented with right upper quadrant pain associated with icteric sclera and melena was suspiciously diagnosed as having malignant cholangiocarcinmoa by abdominal ultrasonography, computed tomography and magnetic resonance imaging [ncbi.nlm.nih.gov]

  Patients with acute DILI who are symptomatic may report malaise, low-grade fever, anorexia, nausea, vomiting, right upper quadrant pain, jaundice, acholic stools, or dark urine. [hindawi.com]

• Regurgitation

  obstructive; jaundice, regurgitation; jaundice, Cholestatic jaundice syndrome, NOS, Cholestatic jaundice, NOS, Obstructive Jaundice, Cholestatic Jaundice Portuguese ICTERICIA COLESTATICA, Icterícia obstrutiva, Icterícia colestática, Icterícia Colestática [fpnotebook.com]

  Called also regurgitation jaundice. physiological jaundice mild icterus neonatorum during the first few days after birth. regurgitation jaundice obstructive jaundice (above). toxic jaundice see hepatocellular jaundice (above). [medical-dictionary.thefreedictionary.com]

  The mechanism by which conjugated bilirubin regurgitates into serum is unclear, but it may differ according to the disease etiology. [emedicine.medscape.com]

  Anyways, the book (Lipoproteins in Helath and Disease ed. by Betteridge, Illingworth, and Shepherd) states four putative mechanisms: -regurgitation of biliary cholesterol -redistribution of itssue cholesterol into plasma -increased hepatic synthesis of [prep4usmle.com]

  Hypertension portálna hypertenzia 2018-04-04 13:52:48 The Primary Malabsorption Syndrome primárny malabsorpčný syndróm 2018-04-04 14:21:51 Pseudomembranous Enterocolitis pseudomembranózna enterokolitída 2018-04-04 11:29:22 Reflux reflux 2018-04-04 10:34:59 Regurgitation [kger.web2v.ukf.sk]

• Abdominal Distension

  He had developed swelling of the feet, abdominal distension and abdominal pain during the last month. There was no history of haematemesis, malena, pruritus or clay-coloured stools, no haemoptysis or breathlessness. [termedia.pl]

  We present the case of a 70-year-old woman who had been suffering from constitutional syndrome for several months, abdominal distension, and yellowish coloration of the skin for the previous few days with a rapidly fatal course. [elsevier.es]

  After surgery, blood coagulopathy was improved immediately Discussion Most patients with cavernous hemangioma are asymptomatic but a minority present with abdominal pain or abdominal distension. [surgicalcasereports.springeropen.com]

   Swelling over the feet, abdominal distension and abdominal pain since last month. • Past alcoholic but had stopped since one year. • Denied any high-risk sexual behavior. Jaundice 3. Normal Bilirubin Metabolism 4. [slideshare.net]

• Thrombosis

  Paroxysmal nocturnal hemoglobinuria (PNH) makes patients susceptible to intravascular hemolysis and thrombosis, and it can be life-threatening in stressful situations. [ncbi.nlm.nih.gov]

  PE, pulmonary embolism; DVT, deep vein thrombosis. [ekjm.org]

  Harker, “Thrombosis and Haemostasis,” In: J. R. McArthur and J. E. Menitove, Eds., Haematology, Copyright American Society of Haematology, Washington DC, 1992, pp. 51-59. [ 5 ] R. D. Hunt, M. E. M. Allison, C. R. M. Prentice and L. H. [dx.doi.org]

• Heart Failure

  Cases have been reported to occur with and without heart failure, although cholestasis is usually more severe in cases with concurrent heart failure.5 There is evidence of a mechanism involving mitochondrial‐induced apoptosis, another theory cites evidence [onlinelibrary.wiley.com]

  Other causes Amyloidosis Pregnancy Chronic right heart failure Chronic pancreatitis Cystic fibrosis Summerskill-Walshe-Tygstrup syndrome (rare) [healthhype.com]

  For example, in infants cholestasis may arise as a result of Gram-negative sepsis, heart failure, metabolic disease or exposure to minimally toxic substances. It is therefore prudent to search beyond the liver for a cause in these patients. [patient.info]

  Tender hepatomegaly can be seen in viral hepatitis, congestive heart failure, and alcoholic hepatitis. In choledocholithiasis and cholecystitis, right upper quadrant (RUQ) tenderness is appreciated. [ncbi.nlm.nih.gov]

• Jaundice

  Our report highlights the varied aetiology of obstructive jaundice and the importance of including biliary ascariasis in the differential diagnosis of the jaundiced patient, especially from endemic areas. [ncbi.nlm.nih.gov]

  Surgery in jaundiced patients is associated with a higher risk of postoperative complications compared with surgery in non jaundiced patients [ 13, 14 ]. [bmcresnotes.biomedcentral.com]

• Hepatomegaly

  Hard & nodular hepatomegaly – ? metastatic malignancy. 6. [slideshare.net]

  Examination revealed hepatomegaly and ascites. Laboratory investigations revealed hyperbilirubinemia with cholestasis. [elsevier.es]

  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]

  Infants are jaundiced and often have dark urine (containing conjugated bilirubin), acholic stools, and hepatomegaly. [msdmanuals.com]

• Scleral Icterus

  […] carotenemia. carotenemia does not cause scleral icterus Hyperbilirubinemia per se has no patho-physiologic effect. [meddean.luc.edu]

  Definition Jaundice: yellowish discoloration of the skin, sclerae, and mucous membranes due to the deposition of bilirubin Scleral icterus: discoloration of the whites of the eyes, starting at serum bilirubin levels > 2–3 mg/dL Jaundice: discoloration [amboss.com]

  icterus is unacceptable to a patient et Võimaldamaks tõhusat ja ametlikku järelevalvet artikli # lõikes # osutatud sööda üle, rakendatakse järgmisi sätteid en It should not be used in patients with myasthenia gravis (a disease of the nerves causing muscle [et.glosbe.com]

  He also had scleral icterus. The remainder of his physical exam including the abdominal exam was normal. [hindawi.com]

  Icterus - cutaneous jaundice is usually seen at serum concentrations of about 85.5 μmol/L but scleral icterus can be seen at concentrations as low as 34.2 μmol/L. Pyrexia - suggests infection or cholecystitis. [patient.info]

• Pruritus

  Prominent features of cholestasis are pruritus and malabsorption of fat and fat-soluble vitamins. [ncbi.nlm.nih.gov]

• Excoriation

  Bile acid resins (cholestyramine or colestipol) are the first line agents in moderate to severe pruritus particularly when associated with excoriations and disturbed sleep. Our patient was started on cholestyramine with symptom improvement. [hindawi.com]

  Pruritus - manifest by scratch marks (excoriation). This is a common but not universal feature (ranging from absent to severely disabling), the exact pathophysiology of which is not clearly understood. [patient.info]

  • 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

  Urinary urobilinogen Other significant findings Prehepatic jaundice Dark ↑↑ Normal Normal ↑↑ (no darkening of urine, but dark urine may occur in the case of hemoglobinuria) Hemolytic markers Anemia Intrahepatic jaundice Pale, clay-colored (rarely dark [amboss.com]

  Patients with medical jaundice will have yellowing of the skin, without dark urine or light-coloured stools. [healthxchange.sg]

  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]

  ‘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.’ [en.oxforddictionaries.com]

• Kidney Failure

  Engelsk definition Functional KIDNEY FAILURE in patients with liver disease, usually LIVER CIRRHOSIS or portal hypertension (HYPERTENSION, PORTAL), and in the absence of intrinsic renal disease or kidney abnormality. [mesh.kib.ki.se]

Based on negative rheumatologic, autoimmune, and infectious causes workup, it was concluded that his cholestatic jaundice was related to Graves’ disease related thyrotoxicosis. [onlinelibrary.wiley.com]

[…] where indicated   • Sepsis Blood culture, full septic workup where indicated Table 2 Summary of recommendations and evidence base for strategies to improve outcome of patients with neonatal cholestasis RECOMMENDATION STRATEGY EVIDENCE Test at 2 weeks [cfp.ca]

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]

• Hypoalbuminemia

  Pericardial tamponade 원인 압력의 변화 심장성(cardiogenic) 좌심실부전 허혈성 심장질환 급성 심근경색 판막질환 고혈압성 심장질환 심근병증(Cardiomyopathy) 체액과부하(volume overload) 부정맥(Arrhythmia) 심내막염 심근염 선천성 심장질환 급성 류마치스열 및 류마치스성 심장질환 High cardiac output states 갑상선기능항진증(Thyrotoxicosis) Beriberi 저알부민혈증(hypoalbuminemia [clinicclinic2.cafe24.com]

• Liver Biopsy

  […] tissue Liver biopsy with EM Genetic analysis   • Neonatal hemochromatosis Ferritin (high, usually > 1000 μg/L) Total iron binding capacity (low) Liver biopsy with iron stain, or buccal mucosal biopsy MRI (abdomen, for typical pattern of iron deposition [cfp.ca]

  Liver biopsy If the investigations point to a cause within the liver, a liver biopsy may be useful in establishing the diagnosis such as bile duct carcinoma (cholangiocarcinoma) or autoimmune disease. [medindia.net]

  Alloimmune liver disease is characterized by elevated hepatic iron stores (increased iron may also be demonstrated using lip biopsy if liver biopsy is not otherwise needed). [msdmanuals.com]

  An accurate diagnosis can usually be made with standard diagnostic techniques, such as history, physical examination and biochemical tests, and, when appropriate, gastrointestinal x-ray studies, cholecystography and cholangiography, liver biopsy, observation [ncbi.nlm.nih.gov]

  Intra hepatic cholestasis CT/MRCP/ ERCP/PTC Serologic studies AMA Hepatitis serologies Hep -A, CMV, EBV Review drugs Negative MRCP/ liver biopsy AMA Positive Liver Biopsy 25. [slideshare.net]

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

The treatment and diet for removing the calculus is almost the opposite of that required to pacify pitta and treat the jaundice. So the vaidyar first started the treatment to remove the calculus or kapha block. [newindianexpress.com]

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]

These observations reflect differences in etiological spectrum from one centre to another. [bmcresnotes.biomedcentral.com]

No other major age differences were observed in the etiological groups. [journalofhospitalmedicine.com]

Liver Biopsy Helpful in intrahepatic cholestasis to evaluate for various possible underlying etiologies. Treatment / Management Management of cholestatic jaundice widely depends upon underlying etiology and type of cholestasis. [ncbi.nlm.nih.gov]

Epidemiology[3] This generally relates to the epidemiology of underlying conditions. Extrahepatic cholestasis accounts for 70% of all cholestasis cases. [patient.info]

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]

[…] due to sickle cell disease Hereditary protoporphyria Bacterial infections, sepsis Cystic fibrosis Ductopenia Familial, drug-induced, chronic allograft rejection, Hodgkin disease, sarcoidosis, primary sclerosing cholangitis, primary biliary cholangitis Epidemiology [ncbi.nlm.nih.gov]

Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. DATA SOURCES: A PubMed was searched for relevant articles published up to August 2016. [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]

References:[2][3][4][5][6][7][8][9] Pathophysiology Jaundice is due to an elevated level of serum bilirubin, which may be caused by prehepatic, intrahepatic, or posthepatic defects. [amboss.com]

Inflammation of the bile duct: This can prevent the secretion of bile and removal of bilirubin, causing jaundice. Obstruction of the bile duct: This prevents the liver from disposing of bilirubin. [medicalnewstoday.com]

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]

Supplements of calcium and vitamin D are often taken if the cholestasis persists, but they are not very effective in preventing loss of bone tissue. [msdmanuals.com]