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Obstructive Jaundice

From Mediwikis

ERCP showing Gallstones

Obstructive Jaundice

Also called post hepatic jaundice. Something blocks the passage of bile (containing conjugated bilirubin) out of the liver and/or bile duct. Therefore it does not reach the duodenum but is instead reabsorbed into the blood stream.

Causes

  • Gallstones
  • Pancreatic cancer
  • Biliary strictures (Primary Sclerosing Cholangitis)
  • Biliary atresia
  • Cholangiocarcinomas
  • Pancreatitis
  • Minizzi’s syndrome
  • Antibiotics – Augmentin and Flucloxacillin

Presentation

  • Pale stool
  • Dark urine
  • Itching – due to deposition of bile salts in skin
  • Jaundice

Investigations

  • Raised total bilirubin – raised conjugated bilirubin with a normal unconjugated bilirubin
  • Low or negative urobillinogen
  • Raised alk phos and gamma GT (typically very raised)
  • Raised ALT and AST (not as high as alk phos and gamma GT)
  • Bilirubin in urine
  • No splenomegaly

Differentiating types of jaundice