Management of obstructive jaundice Done by Soha Ahmed Layan Al-Rasheed Huda Al-Shammeri

Introduction Obstructive jaundice is a condition caused by a blockage in the bile duct that carries bile from the liver to the duodenum.

Causes of obstructive jaundice  Causes of obstructive jaundice can be separated into intrahepatic and extrahepatic.  Intrahepatic causes are most commonly hepatitis and cirrhosis, Drugs e.g thiazides, chlorpromazine, etc.  Extrahepatic causes may be further subdivided into intraluminal, mural,and extramural.

Extrahepatic causes of obstructive jaundice

The following are problems of a jaundiced patients and all must be taken care of before surgery :  Infection due to biliary stasis.  Uncontrolled bleeding due to vit k deficiency.  Liver glycogen depletion.  Dehydration.  Hepatorenal syndrome. preoparative management of obstructive jaundice

preoparative management of obstructive jaundice Fluid resuscitation using dextrose alternate with saline. Catheterization to monitor urine output Broad spectrum antibiotic prophylaxis Parenteral vitamin K +/- fresh frozen plasma Mannitol or any loop diuretics preop, intraop and post op for diuresis to prevent hepatorenal syndrome. Cholestyramine and antihistamine for symptomatic relief of pruritis.

Cholediocholithiasis Ideally ERCP (Endoscopic retrograde cholangiopancreatography) followed by laproscopic cholecystectomy Or open cholecystectomy with CBD exploration.

Head of pancreas cancer Whipple’s operation Pancreatoduodenectomy- remove of head of pancreas and duodenum. Pancreticojejunostomy- anastomosis of distal pancreas to jejunum. Cholecystojejunostomy- anastomosis of common bile duct to jejunum Gastrojejunostomy- anastomosis of stomach to jejunum Cholecyctectomy Antrectomy

Postoperative management Correct Fluid & Electrolyte imbalance Correct hypothermia Adequate analgesia Antibiotics + H2 receptor antagonist Maintain urine output Replace blood and blood products

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