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JAUNDICE Index Case Term 2.

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Presentation on theme: "JAUNDICE Index Case Term 2."— Presentation transcript:

1 JAUNDICE Index Case Term 2

2 Jaundice Definition Causes History Investigation-Imaging
Clinical Cases

3 Definition Jaundice is a yellowing of the skin, conjunctiva and mucous membranes caused by hyperbilirubinaemia.

4 Anatomy


6 Causes excess bilirubin production (Haemolysis)
impaired uptake by the hepatocyte (hepatocellular jaundice) failure of conjugation (hepatocellular jaundice) impaired secretion of conjugated bile into the bile canaliculi (hepatocellular jaundice) impairment of bile flow subsequent to secretion by the hepatocyte (obstructive or cholestatic jaundice)

7 Obstructive Jaundice Common Infrequent Rare Common bile duct stones
Carcinoma of the head of pancreas Malignant lymph nodes at the porta hepatis Infrequent Ampullary carcinoma Pancreatitis Liver secondaries Rare Benign strictures - iatrogenic, trauma Recurrent cholangitis Mirrizi's syndrome Sclerosing cholangitis Cholangiocarcinoma Bilary atresia Choledochal cysts

8 History Abdominal pain, weight change, fever Drug history Injections
Alcohol Transfusion blood, blood products Contact with jaundiced individuals Sexual activity Ingestion raw shellfish, wild mushrooms

9 Jaundice N + Haemolytic +++ ++ Hepatocellular Cholestatic AlkP
Transami nases Bilirubin Liver Function Tests

10 Clinical Case 1 50 year old female Acute, severe pain in RUQ
Nausea and vomiting Calls GP – pethidine pain relief Next few days notices dark urine and pale stools Her husband comments she has a pale yellow tinge

11 Emergency admission What investigations would you do ?
What results would you expect?

12 Abdominal Ultrasound showing multiple gallstones in gallbladder

13 US shows stone in Common Bile Duct

14 MRCP showing stone in Common Bile Duct

15 ERCP showing stone in Common Bile Duct


17 Case 1 Obstructive jaundice due to gallstone in common bile duct
Blood tests show high bilirubin and high alkaline phosphatase Urine contains bilirubin Treatment includes ERCP to remove stone and then plan Cholecystectomy

18 Clinical Case 2 65 year old female Loss of appetite and weight loss
Develops jaundice and itching Scratch marks and bruising Liver enlarged, palpable gallbladder

19 Emergency admission What investigations and what results?

20 Abdominal Ultrasound Dilated common bile duct measuring 14mm
Obstruction at lower end of bile duct Cause not clear on US

21 CT Abdomen Mass in head of pancreas Obstruction of common bile duct
Liver metastasis Peritoneal disease and ascites

22 Endoscopic Ultrasound showing mass in head of pancreas obstructing the CBD

23 EUS Biopsy of pancreatic mass

24 Diagnosis Histology of pancreatic biopsy shows adenocarcinoma.
Not suitable for surgery as already spread to other organs eg peritoneum Relieve jaundice and consider chemotherapy

25 Therapeutic ERCP Put guide wire across the obstruction of CBD
Insert bilary stent Relieves jaundice and some of symptoms

26 In Summary Anatomy Disease processes that cause jaundice
2 Clinical cases of obstructive jaundice Thought about investigation of jaundiced patient

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