Obstructive Jaundice

Introduction

Obstructive Jaundice is a fairly common presentation to the emergency department and surgical teams. The most common cause is gallstones. You may also want to read about Gallstones and Jaundice for more information.

Aetiology of obstructive jaundice

Common

  • Common bile duct stones
  • Carcinoma of the head of pancreas
  • Malignant porta hepatis lymph nodes

Infrequent

Rare

  • Benign strictures - iatrogenic, trauma
  • Recurrent cholangitis
  • Mirrizi's syndrome
  • Sclerosing cholangitis
  • Cholangiocarcinoma
  • Biliary atresia
  • Choledochal cysts

Investigation of obstructive jaundice

Investigation will differentiate hepatocellular and obstructive jaundice in 90% cases

Blood results

  • Conjugated bilirubin >35 mmol/l
  • Increase in ALP / GGT >> AST / ALT
  • Albumin may be reduced
  • Prolonged PTT

Urinalysis findings

  Haemolysis Obstruction Hepatocellular
Conjugated bilirubin normal increased normal
Urobilinogen increased nil normal

 

Ultrasound

  • Normal Common Bile Duct (CBD) <8 mm diameter
  • CBD diameter increases with age and after previous biliary surgery
  • For obstructive jaundice ultrasound has a sensitivity 70 - 95% and specificity 80 - 100%
  • In the future, endoscopic ultrasound may become more widely available

CT Scanning

  • Sensitivity and specificity similar to good quality ultrasound
  • Useful in obese or excessive bowel gas
  • Better at imaging lower end of common bile duct
  • Stages and assesses operability of tumours

Radionucloetide scanning