From the Guidelines
Obstructive jaundice is primarily caused by blockages in the bile flow, which can be due to various factors, including gallstones, tumors, and strictures.
Common Causes of Obstructive Jaundice
- Gallstones (choledocholithiasis): Gallstones can block the common bile duct, leading to obstructive jaundice 1.
- Tumors: Intrinsic and extrinsic tumors, such as pancreatic cancer, can cause obstructive jaundice by blocking the bile ducts 1.
- Strictures: Narrowing of the bile ducts, often caused by primary sclerosing cholangitis, can lead to obstructive jaundice 1.
- Other causes: Parasitic infections, lymphoma, AIDS cholangiopathy, acute and chronic pancreatitis, and strictures after invasive procedures can also cause obstructive jaundice 1.
Key Points
- Obstructive jaundice can be life-threatening and requires prompt treatment, often involving biliary decompression 1.
- The choice of treatment depends on the underlying cause of the obstruction and patient factors, such as anatomy and prognosis 1.
- Endoscopic placement of a permanent self-expanding stent is a common treatment for obstructive jaundice caused by pancreatic cancer 1.
- Initial medical management may be indicated to stabilize hemodynamic status and treat local and systemic infection, followed by biliary decompression 1.
From the Research
Causes of Obstructive Jaundice
The causes of obstructive jaundice are varied and can result from several factors, including:
- Gallstones 2, 3, 4
- Tumors, such as cholangiocarcinoma or pancreatic cancer 2, 4
- Inflammation of the bile ducts 2
- Benign strictures of the biliary tract 4
- Metastatic disease 4
Pathogenesis of Obstructive Jaundice
Obstructive jaundice can lead to several biochemical and physiologic alterations in the biliary tract, including:
- Biliary tract obstruction 3
- Elevated intraluminal pressure 3
- Infection of bile 3
- Bactibilia (presence of bacteria in the biliary tract) 3
- Changes in the host defenses, both in chemotaxis and phagocytosis 3
- Systemic changes, including portal bacteremia, endotoxemia, and increased translocation of endotoxin (LPS) to the liver 3
Diagnostic Approaches
Diagnosing obstructive jaundice involves a thorough diagnostic workup, including:
- Laboratory findings, such as elevated inflammatory markers, bilirubin, liver enzymes, and leukocyte count 2
- Imaging studies, such as abdominal ultrasound, computed tomography scans, and endoscopic retrograde cholangiopancreatography (ERCP) 2, 5, 6
- Brush cytology obtained during ERCP to confirm the presence of a tumor 2
Therapeutic Strategies
The management of obstructive jaundice depends on the underlying cause and may involve:
- Surgical intervention, such as the Whipple procedure (pancreaticoduodenectomy) for resectable distal common bile duct (CBD) adenocarcinoma 2
- Adjuvant chemotherapy to reduce the risk of recurrence 2
- Biliary drainage, anti-infection, nutrition support, coagulation reversal, cardiovascular evaluation, perioperative fluid therapy, and hemodynamic optimization 4