Surgical jaundice

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Surgical jaundice
2015-03-28 09:35:36
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  1. Gallstones typical features
    • - Hx: biliary colic or episodes of chlolecystitis.
    • - Obstructive type
  2. Gallstones pathogenesis
    • - small calibre gallstones -> pass through the cystic duct.
    • - In Mirizzi syndrome the stone may compress the bile duct directly- one of the rare times that cholecystitis may present with jaundice
  3. Cholangitis features
    • - Usu obstructive
    • - Charcots triad: pain, jaundice, fever
  4. Cholangitis pathogenesis
    • - Ascending infection of the bile ducts usually by E. coli
    • - by definition occurring in a pool of stagnant bile.
  5. Pancreatic cancer features
    painless jaundice with palpable gallbladder (Courvoisier's Law)
  6. Pancreatic cancer pathogenesis
    - Direct occlusion: distal bile duct or pancreatic duct by tumour.

    - Sometimes nodal disease at the portal hepatis may be the culprit in which case the bile duct may be of normal calibre.
  7. Bile duct injury pathogenesis
    • - bile duct is excised
    •   + jaundice offers rapidly post operatively
    •   + often due to diff cholecystectomy

    - more insidious: bile duct stenosis <- clips or diathermy injury.
  8. Cholangiocarcinoma
    • - Primary sclerosing cholangitis is a RF
    • - gradual onset obstructive pattern
  9. Diagnosis 1st line 
    what and what it shows
    US of liver and biliary trree

    • establish
    • - bile duct calibre
    • - presence of gallstones
    • - may visualise pancreatic masses and other lesions.

    The most important clinical question is essentially the extent of biliary dilatation and its distribution.
  10. Diagnosis 1st and next
    • * 1st line: US liver and biliary tree
    • * Next if suspect
    • - pancreatic neoplasia: prancreatic protocol CT scan
    • - liver tumours and cholangiocarcinoma: MRI/MRCP. If failed, ERCP. 
    • - PET scans: to stage