Obstructive jaundice

What is obstructive jaundice?

Obstructive jaundice is a particular type of jaundice and occurs when the essential flow of bile to the intestine is blocked and remains in the bloodstream. This might be due to blocked bile ducts caused by gallstones, or tumours of the bile duct which can block the area where the bile duct meets the duodenum. These may be cancerous.

Pancreatic cancer can also be a cause of blockages as it often occurs near to the ampulla of Vater, the tube which joins the pancreas gland to the duodenum.

Other conditions that can cause obstructive jaundice include those that cause pressure on the bile duct such as swelling of lymph glands, scar tissue (from previous infections or surgery), or a cyst, possibly of the pancreas.

What are the symptoms of obstructive jaundice?

Symptoms of obstructive jaundice include yellowing of the skin and whites of the eyes; paler stools and darker urine; and intense itching. Other symptoms vary, depending on the underlying cause of the obstruction although you may also feel tired.

What causes obstructive jaundice?

Obstructive jaundice is a condition in which there is a blockage of the flow of bile out of the liver. This results in redirection of excess bile and its by-products into the blood, and bile excretion from the body is incomplete. Bilirubin, a component of bile, is yellow, which gives the characteristic yellow appearance of jaundice in the skin, eyes, and mucous membranes.

Obstructive jaundice is caused by conditions that block the normal flow of bile from the liver into the intestines including:

The most common cause of obstructive jaundice is the presence of gallstones (cholelithiasis). Other causes of obstructive jaundice are tumors, trauma, cysts, and inflammation in the bile ducts.

• Cholelithiasis (gallstones)
• Biliary stricture (narrowing of the bile duct)
• Cancer of the gallbladder or pancreas
• Cholangitis (infection or inflammation of the common bile duct)
• Congenital structural defects
• Cysts of the bile duct
• Lymph node enlargement
• Pancreatitis
• Parasitic infection
• Trauma, including surgical complications

What are the risk factors for obstructive jaundice?

A number of factors increase your risk of developing obstructive jaundice. Not all people with risk factors will get obstructive jaundice. Risk factors for obstructive jaundice include:

• Abdominal injury
• Gallstones
• Pancreatic cancer
• Tumors in the area of the common bile duct

How is obstructive jaundice diagnosed?

As obstructive jaundice is a serious condition linked to high mortality rates early diagnosis is important. If it is caught early enough a curative operation to remove the blockage is possible, otherwise only palliative treatments that ease the symptoms and which may prolong life are available.

Obstructive jaundice can be diagnosed through various tests including blood tests to examine the level of bilirubin, as well as ultrasound of the liver and bile ducts to find out the exact cause of the obstruction is. CT scans are also used to help examine what is causing the blockage.

What is the treatment of obstructive jaundice?

Treatment depends on what is causing the obstruction; your doctor will advise you about your treatment options. However, these might include surgical resection; ERCP or a procedure known as Percutaneous Transhepatic Cholangiography (PTC) with percutaneous biliary drainage (PTBD). Essentially this allows the drainage of bile that has built up in the liver.