Obstructive jaundice is jaundice due to extrahepatic bile duct or intrahepatic bile duct obstruction, the former is called extrahepatic obstructive jaundice; the latter is called intrahepatic obstructive jaundice.
History of obstructive jaundice
Hepatocellular jaundice is common under 30 years of age, while middle-aged people (over 40 years of age) with a history of right upper abdominal cramps or jaundice are more likely to have stone obstructive jaundice or tumor obstructive jaundice. Progressive worsening of obstructive jaundice or marked fluctuations should be considered intra- and extrahepatic obstruction; pruritus of the skin is more common in obstructive jaundice, especially malignant obstructive jaundice, while hepatocellularity is less common. Extrahepatic obstructive jaundice is deeper, and hepatomegaly may be found on physical examination.
Total bilirubin is an important indicator to evaluate jaundice, and extrahepatic obstructive jaundice can reach 256.2-513 umol/L and rarely fluctuates.
Etiology
Any cause that obstructs the bile ducts will produce obstructive jaundice
Benign etiology
(1) Bile duct stones or gallbladder stones (Mirrizzi’ syndrome) stones obstruct the bile ducts, causing bile to fail to drain into the duodenum.
(2) Patients with chronic pancreatitis form pseudotumors in the head of the pancreas, which compress the bile duct from the outside in.
(3) Stenosis of the bile duct due to inflammation or after surgery.
(4) Other conditions such as rare biliary hemobilia, where a blood clot obstructs the bile duct and causes jaundice; liver fluke or worms that accidentally enter the bile duct.
Etiology of malignant
(1) Malignant tumor of the bile duct itself or of the gallbladder (bile duct cancer).
(2) Cancer of the head of the pancreas.
(3) Carcinoma of the jugular abdomen of the Waite – i.e. duodenal papilla.
(4) Hepatocellular carcinoma with tumor thrombus blocking the bile ducts – the so-called jaundiced hepatocellular carcinoma.
(5) Obstruction of the bile ducts due to compression of the bile ducts by enlarged lymph nodes adjacent to the bile ducts in cancer patients.
Common clinical manifestations of obstructive jaundice
The skin is dark yellow or greenish-brown; the skin has nerve endings and many scratch marks; due to biliary obstruction, the bile cannot enter the intestine and the feces become pale or clay-colored, steatorrhea, yellow warts on the skin, bleeding tendency, osteoporosis, etc.: in cancerous obstruction, the Courviosier’s sign may also appear in the disease analysis.
Diagnostic Differential Folding
Diagnostic points
The diagnosis of this disease is not difficult for patients with a clear diagnosis of hepatocellular carcinoma, which can be diagnosed by the presence of yellow staining of the skin, sclera and urine and elevated bilirubin concentration in the blood, or by elevated bilirubin concentration in the blood without yellow staining of the skin, sclera and urine. Significantly elevated conjugated bilirubin in blood, positive urinary bilirubin, itchy skin seen, and white clay-colored stools are obstructive jaundice; elevated serum conjugated and unconjugated bilirubin, predominantly conjugated bilirubin, positive urinary bilirubin, and elevated urinary bilirubinogen are hepatocellular jaundice.
Differential diagnosis
For patients whose diagnosis of hepatocellular carcinoma is not yet clear and who have jaundice as the first symptom, the diagnosis of this disease has some difficulties. It must be compared with bile duct cancer. Jaundice in hepatocellular carcinoma often has a history of hepatitis and cirrhosis and appears in the late stage of hepatocellular carcinoma, accompanied by right upper abdominal distension and pain, and mostly has elevated blood AFP concentration; while cholangiocarcinoma, pancreatic head carcinoma and duodenal jugular tumor mostly do not have a history of hepatitis and cirrhosis, and only has painless progressive jaundice as the first symptom, and blood AFP concentration is mostly normal, and abdominal ultrasound, CT, MRI, PTC (percutaneous cholangiopancreatography) are often used to diagnose jaundice. puncture hepatic cholangiography), ERCP (endoscopic retrograde cholangiopancreatography). Nuclear cholangiography, angiography and other tests can help to differentiate the above diseases.