What Is Obstructive Jaundice?

Obstructive jaundice is caused by extrahepatic or intrahepatic bile duct obstruction. The former is called extrahepatic obstructive jaundice; the latter is called intrahepatic obstructive jaundice.

Disease CT

Obstructive jaundice

Obstructive jaundice disease definition

Obstructive jaundice is caused by extrahepatic or intrahepatic bile duct obstruction. The former is called extrahepatic obstructive jaundice; the latter is called intrahepatic obstructive jaundice.

Disease CT

History of obstructive jaundice

Under 30 years of age, hepatocellular jaundice is more common, and middle-aged people (over 40 years) with a history of right upper quadrant colic or jaundice are more common as CBD stone obstructive jaundice or tumor obstructive jaundice. Obstructive jaundice with progressive exacerbations or significant fluctuations should be considered within and outside the liver obstruction; obstructive jaundice, especially malignant obstructive jaundice, is more common with itchy skin, but less hepatocellular. Extrahepatic obstructive jaundice is deep, and liver enlargement can be found during physical examination.

TSB: Intrahepatic obstruction of obstructive jaundice is generally rare> 171 umol / L, and extrahepatic obstruction of obstructive jaundice can reach 256.2-513 umol / L, with few fluctuations. Obstructive jaundice AKP: Extrahepatic obstruction or higher, malignant Obstruction is more obvious; ALT: obstructive jaundice is generally <5000U, and liver cells are more than 5000U; fecal and gallbladder excretion is significantly reduced when obstructive jaundice is severe; the feces can be clay-colored.

Causes of obstructive jaundice

Obstructive jaundice for any reason, as long as the bile duct is blocked

One is a benign cause, like the most common

(1) Bile duct stones or stones in the gall bladder (Mirrizzi 'syndrome) block the bile ducts, causing bile to fail to enter the duodenum.

(2) Patients with chronic pancreatitis form a pseudotumor of the pancreatic head, compressing the bile duct from the outside to the inside.

(3) Narrowing of the bile ducts due to inflammation or after surgery.

(4) Others, such as rare bile duct hemorrhage (hemobilia), blood clots block the bile ducts and cause jaundice; liver flukes or worms that enter the bile duct by mistake.

Another is a malignant cause, such as

(1) Malignant tumor of the bile duct itself or the gallbladder (cholangiocarcinoma)

(2) Pancreatic head cancer

(3) Walter's ampulla cancer-duodenal papillary cancer

(4) Tumor thrombus blocks the bile ducts-the so-called jaundice liver cancer

(5) Swelling lymph nodes next to the bile duct in cancer patients compress the bile duct and cause bile duct obstruction.

Obstructive jaundice pathogenesis

Obstructive jaundice disease symptoms

The skin is dark yellow or green-brown, with scarring due to the retention of bile salts in the blood to stimulate skin nerve endings. Due to biliary obstruction, bile cannot enter the intestinal tract and the stool color becomes pale or clay-colored, and urobilinogen is reduced or absent. After bile duct obstruction, the intestinal tract lacks bile acids, cholesterol, and the lack of fat-soluble vitamins. Clinically, it can be manifested as steatosis, skin yellow warts, bleeding tendency, osteoporosis, etc .: Cancerous obstruction can still occur

Disease analysis

Courviosier sign.

Obstructive jaundice disease pathology

Pathological examination showed a large amount of neutrophil infiltration in the manifold area and hepatic sinus.

Obstructive jaundice prone

More common in patients with liver disease.

Obstructive jaundice complications

Hepatorenal syndrome; hepatitis; cirrhosis;

Diagnosis and diagnosis of obstructive jaundice

(A) diagnosis points

For patients with a clear diagnosis of liver cancer, the diagnosis of this disease is not difficult. Patients with liver cancer have yellow staining of skin, sclera, and urine, and elevated bilirubin concentration in the blood, or no yellow staining of skin, sclera, and urine, only Elevated bilirubin concentrations can be diagnosed. Bilirubin in blood was significantly increased, urinary bilirubin was positive, skin was itchy, stool was white clay, obstructive jaundice; serum bound bilirubin and unbound bilirubin were increased, and Erythroglobin-based, urinary bilirubin-positive, increased urobilinogen, hepatocellular jaundice.

(Two) differential diagnosis

For patients whose liver cancer diagnosis is not clear and jaundice is the first symptom, the diagnosis of this disease has some difficulties. Must be associated with bile duct cancer. Identification of pancreatic head cancer and duodenal ampulla tumors. Jaundice of liver cancer often has a history of hepatitis and cirrhosis. It occurs in advanced stages of liver cancer with right upper quadrant abdominal pain and increased blood AFP concentrations. Duodenal ampulla tumors are mostly without history of hepatitis and cirrhosis, with painless progressive jaundice as the first symptom, blood AFP concentrations are mostly normal, abdominal ultrasound, CT, MRI, and PTC (percutaneous transhepatic cholangiopancreatography) ERCP (endoscopic retrograde cholangiopancreatography). Radionuclide biliary angiography, angiography and other examinations are helpful for the identification of the above diseases.

Obstructive jaundice laboratory diagnosis

Biochemical and immunological cancer markers, such as carcinoembryonic antigen (CEA), CA19-9, ferritin, 1 antitrypsin, etc., are helpful for the diagnosis of the cause of cancerous obstruction, but they are not specific. Blood: Serum transaminase is generally not significantly increased, and may be slightly or moderately increased with secondary hepatocyte damage; serum bilirubin is significantly increased, and it can reach 510 / mol / L in complete biliary obstruction ( 30mg / dl), among which the combined bilirubin accounted for more than 35% (to about 60%). Calculus jaundice is often fluctuating; cancerous jaundice is often progressively deepened, but those caused by ampulla can cause a temporary reduction in jaundice due to cancerous ulcers. Serum alkaline phosphatase (ALP), -glutamyltransferase (GT), cholesterol (bile acid and lipoprotein-X (LP-X), etc. were significantly increased. Urine: darker urine color, urine bilirubin positive , Urobilinogen decreases. When the biliary tract is completely blocked, urobilinogen can disappear.

Obstructive jaundice imaging diagnosis

Plain radiographs, X-rays of the gallbladder and biliary tract, B-ultrasound and CT of the abdomen, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC) all contribute to the characterization of obstructive jaundice And positioning diagnostics.

Obstructive jaundice medication

Gan Taile; Yiganling; Potassium and magnesium aspartate; Coenzyme A; Glandular triphosphate; Yinchenhao Decoction addition and subtraction

Obstructive jaundice. The causes of obstructive jaundice. Those conditions can be mistaken for jaundice.

There is a type of pseudo jaundice called carotenemia, which is caused by too much carotene or insufficient thyroid function, and the skin looks yellow and yellow, but it is not really jaundice and must be distinguished. In addition, residents living near the sea often have yellow and red eyes on the white part of the eyes due to sunlight and wind, which may be mistaken for sclera jaundice.