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OBSTRUCTIVE JAUNDICE. DR.JAMIL SAWAKED. DEFITION OF JAUNDICE. YELLOW DISCOLOURATION OF SKIN AND MUCOUS MEMBRANE. TYPES. HAEMOLYSIS. PREHEPATIC. A. HEPATIC . POSTHEPATIC. OBSTRUCTIVE OR SURGICAL. ANATOMY. ANATOMY. A. BILIRUBIN CYCLE. BROKEN DOWN RED CELLS ARE

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obstructive jaundice

OBSTRUCTIVE JAUNDICE

DR.JAMIL SAWAKED

defition of jaundice
DEFITION OF JAUNDICE
  • YELLOW DISCOLOURATION OF SKIN AND MUCOUS MEMBRANE
types
TYPES

HAEMOLYSIS

PREHEPATIC

A

HEPATIC

POSTHEPATIC

OBSTRUCTIVEOR SURGICAL

bilirubin cycle
BILIRUBIN CYCLE
  • BROKEN DOWN RED CELLSARE

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
BILIRUBIN CYCLE CONTINUE

HAEM SPLITS INTO IRON & BILIRUBIN [pigments]

IRON STORED AS FERRITINFOR

REUSE

slide9
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]

slide10

HAEMOGLOBIN

IRON

+RBC WALLPROTEIN

FERRITIN

TO BE REUSED

BILIRUBIN

WATER INSOLUBLE

AMINOACIDS

AMINOACID

POOL

GOES TO THE LIVER FOR CONGUGATIONWITH GLUCOURINIC A.TO BECOME WATER SOLUBLE

BLOOD

URINE

causes of obstructive jaundice
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
CAUSES IN THE LUNEN

ASCARIS

PARASITES

CLONORCHIASIS

HYDATID

PAPILLOMATOSIS

CHOLANGIOCARCINOMA

STONE IS THE COMMONEST

in the wall strictures
IN THE WALL:STRICTURES

BENIGN STRICTURES

MALIGNANT STRICTURES

outside the wall
OUTSIDE THE WALL

L.N.

ANY MASS OUTSIDE

Stone in cystic duct

MIRIZZI SYND

HARTMANN`S POUCH stone

HEAD OF THE PANCREASE

benign strictures
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

BILIARY ATRESIA

NORMAL

the commonest cause
THE COMMONEST CAUSE
  • STONE SLIPPING INTO THE BILIARY TREE
endoscopic view of periampullary tumour
ENDOSCOPIC VIEW OF PERIAMPULLARY TUMOUR

ORIGIN

1-DEUDENAL MUCOSA OR

2-C.B.D. OR

3-PANCREATIC DUCT

cholangiocarcinoma
CHOLANGIOCARCINOMA

LIVER METASTASIS

sclerosing cholangitis
SCLEROSING CHOLANGITIS
  • Associated with U.Colitis in 70% of cases
  • May lead to malignancy
  • Unknown aetiology
  • Symptoms of cholangitis
  • Treatment;Antibiotics
  • Orliver transplant

Rosary beads

شكل المسبحة

symptoms
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
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
DEEP JAUNDICE [GREEN] [OBSTRUCTIVE]
  • VIRCHOW`SNODE

OR

[TROISIER`S SIGN]

BRUISING

VIT.K DEF.

2,4,7,9,10.DEPEND ON IT

courvoisier law
COURVOISIER` LAW

DISTENDED GALL BLADDER

IN CA,HEAD OF PANCREASE

investigations
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.
dilated cbd stone us
DILATED CBD & STONE [US]

Should be more than 6 mm

slide40
ERCP

SPHINCTEROTOMY

slide43
ERCP

C.B.D.STONE

p t c
P.T.C.
  • PERCUTANOUS TRANSHEPATIC

CHOLANGIOGRAM

management 1
MANAGEMENT-1
  • CORRECTION OF THE DERENGED PARAMETRES
  • ADMINISTRATION OF VITAMIN K
  • ANTIBIOTICS
  • MANNITOL PRE, INTRA and POSTOPERATIVELY TO PREVENT

HEPATO-RENAL SHUTDOWN

management 2
MANAGEMENT-2
  • 1. STONE-SPHINCTEROTOMY
  • 2.STONE-EXPLORATION OF C.B.D.
  • 3.STRICTURE-RESECTION ANASTOMOSIS FORSHORT 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

whipple s operation
WHIPPLE`S OPERATION

Pancreatico-duodenoctomy

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