OBSTRUCTIVE JAUNDICE DR.JAMIL SAWAKED
DEFITION OF JAUNDICE YELLOW DISCOLOURATION OF SKIN AND MUCOUS MEMBRANE
TYPES A HEPATIC POSTHEPATIC PREHEPATIC OBSTRUCTIVE OR SURGICAL HAEMOLYSIS A PREHEPATIC HEPATIC POSTHEPATIC OBSTRUCTIVE OR SURGICAL
ANATOMY
ANATOMY A
BILIRUBIN CYCLE BROKEN DOWN RED CELLS ARE REMOVED BY R.E.S. HAEMOGLOBIN SPLITS INTO HAEM &GLOBIN GLOBIN & CELL WALL PROTEIN GO DOWN TO AMINOACIDS THEY ENTER THE AMINO ACID POOL
BILIRUBIN CYCLE CONTINUE HAEM SPLITS INTO IRON & BILIRUBIN [pigments] IRON STORED AS FERRITIN FOR REUSE
Van den Bergh reaction [DIRECT] BILIRUBIN IS NOT REUSED [GOES TO THE LIVER] COMBINE WITH GLUCOURINC ACID TO FORM THE CONJUGATED [ DIRECT ] BILIRUBIN [ WATER SOLUBLE ] Van den Bergh reaction [DIRECT] Alcohol added after van den Gergh [INDIRECT]
HAEMOGLOBIN IRON +RBC WALL PROTEIN FERRITIN BILIRUBIN TO BE REUSED WATER INSOLUBLE AMINOACIDS AMINOACID POOL GOES TO THE LIVER FOR CONGUGATION WITH GLUCOURINIC A.TO BECOME WATER SOLUBLE BLOOD URINE
URINE IN OBSTRUCTIVE JAUNDICE TEA COLOUR
BILIRUBIN CYCLE
DEEP JAUNDICE [OBSTRUCTIVE]
CAUSES OF OBSTRUCTIVE JAUNDICE 1-STONES 2-STRICTURES; [BENIGN] 3-CA. HEAD OF THE PANCREASE 4-CHOLANGIOCARCINOMA 5-PERIAMPULLARY TUMOUR 6-PRESSURE FROM OUTSIDE;L.N.,M.SYN. 7-CHOLEDOCHAL CYST 8-PARASITES; FILLING THE LUMEN
CAUSES IN THE LUNEN STONE IS THE COMMONEST HYDATID ASCARIS PARASITES CLONORCHIASIS HYDATID PAPILLOMATOSIS CHOLANGIOCARCINOMA STONE IS THE COMMONEST
IN THE WALL:STRICTURES BENIGN STRICTURES MALIGNANT STRICTURES
OUTSIDE THE WALL L.N. ANY MASS OUTSIDE MIRIZZI SYND Stone in cystic duct MIRIZZI SYND HARTMANN`S POUCH stone HEAD OF THE PANCREASE
MIRRIZI`s syndrome
BENIGN STRICTURES 1-BILIARY ATRESIA 2-IATROGENIC BILIARY SURGERY GASTRECTOMY HEPATIC RESECTION LIVER TRANSPLANT 3-INFLAMMATORY;CHOLANGITIS , PANCREATITIS, SCLEROSING CHOLANANGITIS. 4-TRAUMA 5-IDIOPATHIC 6-RADIOTHERAPY
BILIARY ATRESIA BILIARY ATRESIA NORMAL
CAUSES
THE COMMONEST CAUSE STONE SLIPPING INTO THE BILIARY TREE
IMPACTED STONE AT THE LOWER END OF C.B.D.
ASSENDING CHOLANGITIS WITH LIVER ABSESSES
CA. HEAD OF THE PANCREASE
ENDOSCOPIC VIEW OF PERIAMPULLARY TUMOUR ORIGIN 1-DEUDENAL MUCOSA OR 2-C.B.D. OR 3-PANCREATIC DUCT
CHOLANGICARCINOMA
CHOLANGIOCARCINOMA LIVER METASTASIS
C.B.D.STRICTURE
SCLEROSING CHOLANGITIS Associated with U.Colitis in 70% of cases May lead to malignancy Unknown aetiology Symptoms of cholangitis Treatment;Antibiotics Or liver transplant Rosary beads شكل المسبحة
SYMPTOMS PAIN YELLOW DISCOLOURATION SKIN &M.M. DARK URINE [TEA COLOUR] CLAY COLOUR STOOL لون الطحينية ITCHING FEVER IF CHOLANGITIS SUPERVENE LOSS OF APPETITE LOSS OF WEIGHT IN MALIGNACY
SIGNS LOSS OF Wt. IN MALIGNANCY TOXIC IN CHOLANGITIS, [CHARCOT`S TRIAD,;PAIN, FEVER ,JAUNDICE] YELLOW DISCOLOURATION OF SKIN,M.M. TROISIER`S SIGN. VIRCHOW`S NODE TENDER R.U.Q.[IN CHOLANGITIS] COURVOISIER` LAW[IN CA.HEAD OF PAN.] ABDOMINL MASS ASCITES[IN MAIGNANCY]
DEEP JAUNDICE [GREEN] [OBSTRUCTIVE] VIRCHOW`S NODE OR [TROISIER`S SIGN] BRUISING VIT.K DEF. 2,4,7,9,10.DEPEND ON IT
COURVOISIER` LAW DISTENDED GALL BLADDER IN CA,HEAD OF PANCREASE
ASCITES IN ADVANCED CA. HEAD OF PANCREASE
INVESTIGATIONS C.B.C. DIFF., ESR. L.FT. *S.ALK.P.* PROTHROMBIN TIME S. AMYLASE K.F.T. ELECTRLYTES URINE ANALSIS * BILIRUBIN * STOOL ANALYSIS,;FAT,BLOOD.
INVESTIGATIONS U.S. STONE
DILATED CBD & STONE [US] Should be more than 6 mm
C.T. DOUBLE BURRLE SIGN &DISTENDED G. PERIAMPULLARY TUMOUR
ERCP SPHINCTEROTOMY
STONE EXTRACTION BY BASKET
STONE EXTRACTION BY BALLON
ERCP C.B.D.STONE
C.B.D. BIG STONE
STENT
STONE REMOVED
C.B.D. STRICTURE
C.B.D.STENT WITH GOOD FLOW
CHOLANGICARCINOMA
CHOLANGIOCARCINOMA
E.R.C.P.FOR EXTRAHEPATIC CHOLANGIOCARCINOMA
ENDOSCOPIC VIEW OF PERIAMPULLARY TUMOUR
M.R.C.P
P.T.C. PERCUTANOUS TRANSHEPATIC CHOLANGIOGRAM
PEROPERATIVE CHOLANGIOGRAM
T.TUBE CHOLANGIOGRAM
DRAIN CHOLANGIOGRAM
MANAGEMENT-1 CORRECTION OF THE DERENGED PARAMETRES ADMINISTRATION OF VITAMIN K ANTIBIOTICS MANNITOL PRE, INTRA and POSTOPERATIVELY TO PREVENT HEPATO-RENAL SHUTDOWN
MANAGEMENT-2 1. STONE-SPHINCTEROTOMY 2.STONE-EXPLORATION OF C.B.D. 3.STRICTURE-RESECTION ANASTOMOSIS FOR SHORT STRICTURES 4.STRICTURE-STENT FOR SHORT AND LONG 5.CA.HEAD OF THE PANCREASE =EARLY-WHIPPLE`S OPERATION[PANCREATICO-DUODENECTOMY. =LATE-BYPASS SURGERY[CHOLECYSTO-JUJENOSTOMY
STENT FOR Ca. head of pancrease
Pancreatico-duodenoctomy WHIPPLE`S OPERATION Pancreatico-duodenoctomy