obstructive jaundice l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Obstructive jaundice PowerPoint Presentation
Download Presentation
Obstructive jaundice

Loading in 2 Seconds...

play fullscreen
1 / 14

Obstructive jaundice - PowerPoint PPT Presentation


  • 543 Views
  • Uploaded on

Obstructive jaundice. I C Cameron. Acute on call. Deranged LFTs, esp Alk Ph and GGT Conjugated Bilirubin high Take a good history Onset, drugs, pain, previous attacks, alcohol, gallstones, pale stools, dark urine, wt loss Look for signs of liver failure USS - gallstones?

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Obstructive jaundice' - adamdaniel


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
acute on call
Acute on call
  • Deranged LFTs, esp Alk Ph and GGT
  • Conjugated Bilirubin high
  • Take a good history
  • Onset, drugs, pain, previous attacks, alcohol, gallstones, pale stools, dark urine, wt loss
  • Look for signs of liver failure
  • USS - gallstones?

- dilated CBD +/- dilated IH ducts

common causes
Common causes
  • Gallstones and carcinoma of pancreas
  • Rare cholangiocarcinoma, pancreatitis
  • USS > 90% gallstones
  • No gallstones or significant pain – CT
  • Avoid knee-jerk ERCP
  • Serial LFTs vital – fluctuant or progressive
  • GS in GB but history equivocal - MRCP
case presentation
Case Presentation
  • 52 year old man, previously fit and well
  • 2 week Hx progressive J, dark urine
  • Vague abdo discomfort
  • Uss – gallstones in thin walled GB

- dilated CBD 14mm, poor views

  • Next move?
slide7
ERCP
  • 1st attempt failed, oedematous papilla
  • Bilirubin continues to rise
  • Next move?
2 nd ercp
2nd ERCP
  • No deep cannulation, cholangiogram
  • Short stricture distal CBD stricture
  • PD normal
  • What next?
patient becomes very unwell
Patient becomes very unwell
  • Pain, pyrexia, amylase 1370
  • IVI, catherterised, inotropes, HDU
  • 3 days: bilirubin increased, much better
  • Priority?
drain biliary system
Drain biliary system
  • PTC and external drain
  • CT scan + Transfer
rhh management
RHH management
  • Repeat PTC and internalise stent
  • Bilirubin falling
  • CT review – inflammatory mass centred around HOP, stranding in soft tissue
  • Conservative treatment
  • Next step?
repeat ct
Repeat CT
  • 8 weeks later repeat CT – infl change better
  • 2 weeks later – exploratory laparotomy
  • Inflammatory mass involving HOP, stomach, duodenum , TC
  • No procedure
clinic follow up
Clinic follow up
  • Probable distal CBD cholangiocarcinoma
  • Never well enough for chemotherapy
  • Deceased 7 months later
lessons to learn
Lessons to learn
  • What Ix after USS?
  • Avoid ERCP if at all possible
  • Preop biliary drainage 20% complication rate (less with PTC and stent)
  • Obst jaundice with GS odd history