Jaundice is a common clinical sign that results from yellow pigmentation of skin, mucous membrane or sclera because of impaired excretion or production of bile. Any mechanical obstruction extra hepatic or intra hepatic, which prevents excretion of normally produced bile to reach into the intestine, causes obstructive jaundice. Therefore obstructive jaundice broadly classified into two-:
1. Intra hepatic Cholestasis
2. Extra hepatic Cholestasis.
Causes of obstruction—
A) Extrahepatic obstruction –
Intrapancratic obstruction – The 3 common conditions that cause 90% of the biliary obstruction occur at the level of the distal duct. These conditions are Choledocholithiasis, chronic pancreatitis and pancreatic carcinoma.
Suprapancreatic obstruction – This is defined as an obstruction that develops between the pancreas & porta hepatis. This occur in less than 10% of patients and most often due to primary bile duct malignancy ( Cholangiocarcinoma) or metastatic adenopathy.
Porta hepatis obstruction-- Common causes tumour arising from GB and liver with local spread.Primary cholangiocarcinoma(Klatskin’s) and postsurgical stricture are uncommon causes.
Unusual causes of obstruction -- Cholangitis , parasitic infestation, developmental abnormalities, hemobilia and postsurgical cholecystectomy stricture. Recurrent pyogenic cholangitis associated with parasitic infestations specially clonorchis sinensis, ascariasis, bacterial infection thatis E-coli can lead to multiple stricture and massive dilatation.
Choledochal cyst- Cause extrahepatic biliary obstruction. Subtypes are local,cystic,aneurismal or fusiform dilatation of extrahepatic duct.Complications are biliary obstruction,recurrent bacterial cholangitis & biliary neoplasia.
Hemobilia—Defined as bleeding within biliary tract because of trauma,endoscopic intervention, postoperative,coagulopathy or in severe liver disease etc.
Primary sclerosing cholangitis- Commonly associated with ulcerative colitis & crohn’s disease.Cholangiographic appearance shows non uniform segmental intrahepatic biliary dilatation with beading & pruning of duct Extrahepatic duct is also involves similarly.
Mirizzi’s syndrome – Occurs when a large calculus is impacted at the neck of the gall bladder or cystic duct causes extrinsic mechanical pressure on common hepatic duct causing obstructive jaundice.
