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Obstructive Jaundice

Cholestatic Jaundice


Presentation

  • In this case report, we present an 18-month old infant with Fontan circulation presenting with jaundice secondary to Morgagni hernia who ultimately underwent laparoscopic repair.[ncbi.nlm.nih.gov]
  • We present the first reported case of histiocytic sarcoma presenting as a pancreatic mass, diagnosed by endoscopic ultrasound guided fine-needle aspiration (EUS-FNA).[ncbi.nlm.nih.gov]
  • 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]
  • ) 9 (intrahepatic mass lesion-0 if absent, 1 if present).[ncbi.nlm.nih.gov]
  • Usually unifocal, SCAs present as single, large, well-demarcated, multiloculated, cystic tumors, 1-25 cm in size. A 73-year-old man initially presented with epigastric abdominal pain and was diagnosed with SCA involving the whole pancreas.[ncbi.nlm.nih.gov]
Respiratory Distress
  • The vast majority of congenital diaphragmatic cases present with severe respiratory distress in the immediate neonatal period.[ncbi.nlm.nih.gov]
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]
  • Vitamin A supplements prevent deficiency and severe steatorrhea can be minimized by replacing some dietary fat with medium-chain triglycerides.[ptolemy.ca]
  • 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]
  • . • 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]
Jaundice
  • The mean AT of the contrast agent was 2.0 1.8 and 6.1 2.3 s in the jaundice and improved jaundice phases, respectively, showing significantly shorter AT in the jaundice phase (p 0.0033).[ncbi.nlm.nih.gov]
  • After excluding pathological T1 (UICC) patients (n 11), the remaining 65 patients were divided into 2 groups; jaundiced group (n 37) and non-jaundiced group (n 28).[ncbi.nlm.nih.gov]
  • Patients with metastatic colorectal cancer can develop jaundice from intrahepatic or extrahepatic causes. Currently, there is little data on the underlying causes and overall survival after onset of jaundice.[ncbi.nlm.nih.gov]
  • The HCC patients with BDTT who presented with obstructive jaundice demonstrated outcomes similar to those for the HCC patients with BDTT who did not present with obstructive jaundice in terms of the overall survival rate (p 0.5469).[ncbi.nlm.nih.gov]
  • Secondary to PDA, obstructive jaundice is however an extremely rare manifestation. A case of an 84-year-old man is reported here, who suffered from severe jaundice caused by a ruptured PDA associated with CAS.[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]
  • ; devine vizibil intre a 2-a si a 5-a zi dupa nastere si dispare in 1-2 saptamani de secretie se datoreaza tulburarilor de secretie a BRC la polul biliar al hepatocitului si BRC ,bilirubinurie, scaune hipocolice icter, manifestari digestive minore, hepatomegalie[quizlet.com]
  • The examination findings revealed that 24 (21.8%) patients had hepatomegaly, 20(18.2%) had palpable gallbladder.[ispub.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] .[emedicine.medscape.com]
Dark Urine
  • 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]

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

  • Responders to treatment showed a better OS than nonresponders (1-year OS, 52% vs 0%; p 0.01). TACE and radiotherapy resulted in relatively good treatment responses of 64% and 67%, respectively.[ncbi.nlm.nih.gov]
  • Computed tomography and angiography are useful tools for diagnosis and treatment plan. Any GDA aneurysm should be considered for definitive treatment. Recently, endovascular intervention has gained popularity for its safety and efficacy.[ncbi.nlm.nih.gov]
  • The administration of corticosteroids resolved the obstructive jaundice without surgical treatment or endoscopic drainage. Obstructive jaundice caused by IRIS should first be treated with corticosteroids before invasive treatment.[ncbi.nlm.nih.gov]
  • However, the two groups were similar in number of complications (OR 0.84; 95% CI 0.45-1.56; P 0.578), post-treatment reduced level of total bilirubin (TBIL) (MD 22.71; 95% CI - 7.24-52.65; P 0.14), post-treatment reduced level of direct bilirubin (DBIL[ncbi.nlm.nih.gov]

Prognosis

  • To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma.[ncbi.nlm.nih.gov]
  • The prognosis is poor in these patients.[ncbi.nlm.nih.gov]
  • Furthermore, the prognosis of the patients was analyzed.[journalofhospitalmedicine.com]
  • The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainage efficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients with malignant obstructive jaundice need to biliary drainage[ncbi.nlm.nih.gov]
  • Unresectable HCC with obstructive jaundice has a poor prognosis. However, effective biliary drainage and treatment of HCC such as with TACE or radiotherapy improves survival.[ncbi.nlm.nih.gov]

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]
  • The highest level of LPO was associated with malignant etiology of the disease. The logistic regression analysis showed that the age of the patient and the levels of LPO in blood were predictors of renal dysfunction in OJ patients.[ncbi.nlm.nih.gov]
  • No other major age differences were observed in the etiological groups.[journalofhospitalmedicine.com]
  • Livers from patients with hepatitis of unknown etiology have shown more evidence of inflammation, cell necrosis and portal fibrosis than the others.[pediatrics.aappublications.org]

Epidemiology

  • Outline of Discussion • Definition • Epidemiology • Classification • Pathophysiology • Clinical evaluation • Management 3.[slideshare.net]
  • 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]
  • Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management. 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]
  • 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]
  • 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]
  • 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]
  • 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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