Study of Presentation,Evaluation and Management of Obstructive jaundice in JLNMCH Bhagalpur, Bihar Obstructive jaundice ---A review

Dr Chandra mauli Upadhyay; Dr Neetish Kumar

Volume : IX, Issue : V, May - 2020

Study of Presentation,Evaluation and Management of Obstructive jaundice in JLNMCH Bhagalpur, Bihar Obstructive jaundice ---A review

Dr Chandra Mauli Upadhyay, Dr Neetish Kumar

Abstract :

Jaundice is a generic term, which describes yellow pigmentation of the skin, mucous memane or sclera. Obstructive jaundice is a surgical problem that occurs when there is an obstruction to the passage of bile from the liver cells to the intestine . It contributes significantly to morbidity and mortality . Early diagnosis of the cause is very important especially in malignant cases as curative resection is only possible in the early stages The most common causes of obstructive jaundice are choledocholithiasis,strictures of the biliary tract, cholangiocarcinoma, carcinoma of pancreas, pancreatitis, parasites and primary sclerosing cholangitis. Diagnosis of this syndrome is based on clinical examination, laboratory findings, imaging and endoscopic examination. Regardless of the cause, the physical obstruction causes a predominantly conjugated hyperbilirubinemia. Obstructive jaundice can be complicated with renal dysfunction, hemostasis impairment, hepatic dysfunction, increased intestinal permeability, and other complications. When mechanical biliary obstruction is diagnosed, surgical, endoscopic or radiologic intervention is usually recommended. Endoscopic Retrograde Cholangiopancreatography is an established diagnostic and therapeutic tool for pancreaticobiliary diseases including choledocholithiasis. However, Magnetic Resonance Cholangiopancreatography has gradually become an alternative diagnostic tool and is considered to be a noninvasive diagnostic technique in biliary diseases. In patients, in which gallbladder stones are associated with common bile duct stones, there is no consensus whether laparoscopic or endoscopic approach should be the first treatment. In spite of the advances made in diagnostic procedures over the past several decades, only about 20% of pancreatic cancers are found to be resectable at the time of presentation. Various palliative therapeutic strategies have been described. Today, the most common treatments are endoscopic biliary stenting and surgical biliary bypass surgery. The recommendation is that endoscopic stenting should be performed in patients with a poor prognosis (i.e., a life expectancy less than six months), and that patients with a life expectancy of greater than six months should be treated with biliary bypass because of the better long–term results associated with surgery.