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    Doc1 Obstractive Jaundice

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    Zhy Caluza
    Obstructive jaundice occurs when the outflow of bile from the liver is obstructed, which is most commonly caused by gallstones in the common bile duct. Other potential causes include cancers of the bile duct or pancreas, as well as benign strictures from chronic pancreatitis. Patients typically present with jaundice and other symptoms like pale stools and dark urine. An accurate diagnosis can usually be made through a combination of history, physical exam, biochemical tests, and imaging like cholangiography. Early detection of the underlying cause is important to help guide appropriate management and improve patient outcomes and survival rates.

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    Doc1 Obstractive Jaundice

    Uploaded by

    Zhy Caluza
    69 views7 pages
    Obstructive jaundice occurs when the outflow of bile from the liver is obstructed, which is most commonly caused by gallstones in the common bile duct. Other potential causes include cancers of the bile duct or pancreas, as well as benign strictures from chronic pancreatitis. Patients typically present with jaundice and other symptoms like pale stools and dark urine. An accurate diagnosis can usually be made through a combination of history, physical exam, biochemical tests, and imaging like cholangiography. Early detection of the underlying cause is important to help guide appropriate management and improve patient outcomes and survival rates.

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    Obstructive jaundice occurs when the outflow of bile from the liver is obstructed, which is most commonly caused by gallstones in the common bile duct. Other potential causes include cancers of the bile duct or pancreas, as well as benign strictures from chronic pancreatitis. Patients typically present with jaundice and other symptoms like pale stools and dark urine. An accurate diagnosis can usually be made through a combination of history, physical exam, biochemical tests, and imaging like cholangiography. Early detection of the underlying cause is important to help guide appropriate management and improve patient outcomes and survival rates.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    69 views7 pages

    Doc1 Obstractive Jaundice

    Uploaded by

    Zhy Caluza
    Obstructive jaundice occurs when the outflow of bile from the liver is obstructed, which is most commonly caused by gallstones in the common bile duct. Other potential causes include cancers of the bile duct or pancreas, as well as benign strictures from chronic pancreatitis. Patients typically present with jaundice and other symptoms like pale stools and dark urine. An accurate diagnosis can usually be made through a combination of history, physical exam, biochemical tests, and imaging like cholangiography. Early detection of the underlying cause is important to help guide appropriate management and improve patient outcomes and survival rates.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 7

    INTRODUCTION

    Obstructive jaundice (surgical jaundice) in simple terms means the outflow of bile has been obstructed
    anywhere from the liver to the duodenum.

    A correct pre-operative diagnosis in almost always possible today because of advances in imaging
    techniques over the decades.

    Removal of block relieves the symptoms and often results in cure. In present day world surgical jaundice
    has become more of a medical entity as most of the obstructive jaundice cases are managed by
    Gastroenterologists by ERCP or by stenting rather than by surgeons.

    There are varied causes of obstructive jaundice, but it is most commonly due to choledocholithiasis (also
    called bile duct stones or gallstones in the bile duct) – presence of a gallstone in the common bile duct
    Other causes like, malignancies such as cholangiocarcinoma, periampullary and pancreatic cancers, and
    benign stricture including chronic pancreatitis have become increasingly prevalent.

    There as also rise in iatrogenic causes of obstructive jaundice, like injury of biliary tract and cholangitis
    with the increase of invasive procedures performed on the biliary tract.

    Biliary tract disorders can be significantly found in worldwide population, and the quite majority of cases
    are attributable to choledocholithiasis. 20% of persons older than 65 years in USA have gallstones and
    around 1 million newly diagnosed cases of choledocholithiasis are reported every year. Patients with
    obstructive jaundice usually present with complain of yellow skin and eyes, pale stools, dark coloured
    urine, jaundice, and pruritus. Abdominal pain often misleading for diagnosis– some patients with
    choledocholithiasis have painless jaundice, whereas some patients with hepatitis have distressing pain in
    the right upper quadrant. Malignancy often associated with the absence of pain and tenderness during
    the physical examination.
    Patients with obstructive jaundice have tendency to develop nutritional deficits, infectious
    complications, acute renal failure, and impairment of cardiovascular function. Other adverse events
    such as coagulopathy, hypovolemia, and endotoxemia can be insidious and significantly increase
    mortality and morbidity. An accurate diagnosis can usually be made with combination of different
    approaches like, history, physical examination, and biochemical tests, and when appropriate
    cholangiography and liver biopsy and observation of the patient's course.

    Early and precise detection of etiology of obstructive jaundice can help surgeons to accurately manage
    such patients and thus will improve quality of life of patient and improving the survival rates among the
    patients with malignant pathology. Hence, present study was undertaken study the clinical profile of
    patients with obstructive jaundice..
    Pathophysiology

    Anatomy

    Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper


    gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts
    Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of
    gallstones that form in your gallbladder and become stuck in your common bile ductinfection
    acute pancreatitis
    chronic pancreatitis
    trauma or surgical complications in your bile or pancreatic ducts
    pancreatic pseudocysts
    tumors or cancers of the bile ducts
    tumors or cancers of the pancreas

    What’s a T-Tube? It’s a t-shaped tube that is placed in the bile duct to help drain
    excessive bile and can be used for testing to assess the biliary tree and ducts.

    What would a patient have a t-tube?

     Cholecystectomy: It’s sometimes placed after the removal of the gallbladder. A


    cholecystectomy may need to be performed because the gallbladder is inflamed
    (cholecystitis) or there are gallstones (which leads to gallbladder inflammation).
     Common bile duct exploration: This is where an incision is made in the bile
    duct to assess the duct…sometimes gallstones may become lodged within this
    network of ducts. It may be performed during a cholecystectomy, especially if
    gallstones were the cause for the removal of the gallbladder. A t-tube will be
    placed to help out the duct as it heals and swelling decreases, and then it will be
    removed.
     Liver transplant
    Role of the t-tube? It will serve as a drain that will drain off excessive bile and will be
    removed once healing has taken place. It can also be used for testing where dye is
    injected into the t-tube and x-ray imaging is taken (cholangiogram) to assess the biliary
    tree and duct like the picture below.

    Nursing Care of T-Tubes


    “Drain”

    Drainage bag positioned correctly

     WHY? The collection bag drains bile with the help of gravity.


     Keep tubing untangled/kink-free and keep the tubing/drainage bag below the site
    of insertion (needs to be at or below the waist level).
     To help facilitate drainage keep patient is Semi-Fowler’s position…30-45 degree
    angle.
     Prevent dislodgement! Teach patient how to prevent pulling drain out by never
    putting tension on the tubing (example: avoid sleeping on it, keep it secured while
    ambulating or moving).
    Record and empty drainage per facility’s protocol

     WHY? This helps make sure the t-tube is draining because they can become
    blocked, leak bile into the abdominal cavity (leading to peritonitis), or there is
    excessive drainage (bleeding etc.).
     Fresh post-op (1-2 days): drainage starts out with some blood and then
    progresses to a greenish/yellow/brown liquid drainage.

    o Drainage should NOT be more than 500 mL/day (notify MD if this


    happens)…the drainage will decrease as the patient recovers.
    Assess color and consistency of drainage

     Document…color should be yellowish greenish/brownish

    o watch for extremely thick, bad smelling drainage with a fever or extremely
    bloody like bright red blood that looks fresh)
    Inspect skin and abdomen frequently

     Change dressing (keep it dry and clean)…bile is very harsh on the skin
     Monitor for bile leakage into abdomen (bile peritonitis)

    o bloating, abdominal pain (especially with palpated), n/v, diarrhea, fever


    Need physician’s order to clamp or flush the t-tube

     Flush to maintain patency with a standing doctor’s order


     The doctor may order the t-tube to be clamped at times so bile can drain to the
    duodenum so fats can be digested during meal times…follow MD’s specific
    orders. Example: Clamp 1 hour before and 1 hour after meals.

    o Assess how well patient tolerated the t-tube being clamped…if patient
    develops abdominal pain, nausea vomiting etc. unclamp it and notify MD.
    o Clamping the t-tube tell us how well the bile duct is working to deliver the
    bile and if the patient will be able to tolerate not having the t-tube once it’s
    removed.

    REFERENCES
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    Cholestatic Hepatitis). In: StatPearls. Treasure
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    decades advances in therapeutic endoscopy. World J
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