Obstructive jaundice- Introduction

In this ppt I have discussed the different causes for obstructive jaundice, anatomy of biliary tract, physiology of jaundice, labs in obstructive jaundice and an algorithm to diagnose obstructive jaundice.

1. OBSTRUCTIVE JAUNDICE INTRODUCTION Dr.B.Selvaraj MS;Mch;FICS ; Professor Of Surgery Melaka Manipal Medical college Melaka 75150 Malaysia

2. Must to know core clinical problems 1. Acute RLQ pain 2. Acute RUQ pain 3. Acute epigastric pain 4. Acute LLQ pain 5. Dysphagia 6. Abdominal lumps 7.Upper GI haemorrhage 8. Lower GI haemorrhage 9. Obstructive Jaundice 10. Breast lumps, mastalgia & nipple discharge 11. Neck swellings- Thyroid & non thyroidal 12.Groin swellings 13.Scrotal swellings 14. Limb ischemia- Acute & Chronic 15. Varicose veins 16. Renal & ureteric colic 17. Hematuria 18. Acute retention of urine

3. Obstructive Jaundice- Introduction Causes of obstructive jaundice Anatomy of biliary tract Physiology of jaundice Labs in obstructive jaundice Algorithm in obstructive jaundice

4. Obstructive Jaundice- Causes Intraluminal causes: - C holedocholithiasis - Clonorchis sinensis - Ascariasis & Schitosomiasis Mural causes: - Malignant stricture-cholangiocarcinoma - Benign stricture- Scelerosing cholangitis Extrinsic Causes: - Ca Head of Pancreas - Periampullary Carcinoma, Portal LN

5. Anatomy of Biliary Tract

6. Physiology of Jaundice

7. Labs in all types of Jaundice

8. Labs in Obstructive Jaundice Bilirubin in the urine (characteristic dark colouration) this occurs as the bilirubin is conjugated and thus water-soluble No urobilinogen in the urine; due to the obstruction, no bilirubin enters the bowel to be converted to urobilinogen. Increased total bilirubin and direct bilirubin(conjugated bilirubin) Increased canalicular enzymes: alkaline phosphatase and GGT Increased liver enzymes ALT and AST; not as significant as seen in hepatocellular causes, but biliary backpressure inevitably leads to mild hepatocyte damage .

9. Obstructive Jaundice- Diagnostic Algorithm

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