jaundice
Preface
Conclusion
Pathogenesis
biliary obstruction
cause
Imaging studies
Transabdominal ultrasonography(US) is the procedure of choice for the initial evaluation of cholestasis. It’s the least expensive, safest, and most sensitive imaging study for visualizing the gallbladder. US can show cholelithiasis, but it’s not as useful for CBD stones because bowel gas may obscure visualization
Cholestasis, defined as obstruction of biliary flow, can be caused by mechanical factors, such as biliary strictures, or by metabolic factors such as hepatotoxicity due to certain.Cholestasis can also have either intrahepatic or extrahepatic etiologies.
Endoscopic ultrasound (EUS) allows complete visualization of the biliary system, can detect small CBD stones, and is also highly accurate for detecting pancreatic tumors. EUS has been reported to have up to a 98% diagnostic accuracy in patients with obstructive biliary disease.
Intrahepatic cholestasis generally occurs at the level of the hepatocyte or biliary canalicular membrane.
Extrahepatic cholestasis can be subdivided into those that are intraductal or extraductal.
computed tomography (CT)scan is usuallyconsidered more accurate than US for helpingdetermine the specific cause and level of obstruction.It also provides better visualization of liver structures.The use of contrast media helps define vascularstructures and the pancreas.
Endoscopic retrograde cholangiopancreatography (ERCP) combines
endoscopic and radiologic modalities to visualize both the biliary and pancreatic duct systems. It’s considered the gold standard for imaging the biliary tree. It’s also used therapeutically; someobstructions discovered during ECRP can be treated by performing a sphincterotomy, removing stones, and placing stents.
Magnetic resonance cholangiopancreatography (MRCP) provides visualization and measurements of the bile and pancreatic ducts. MRCP provides a diagnostic cholangiogram in 90% to 100% of patients and reveals the level of obstruction in 80% to 100% of cases.
Intraductal causes include choledocholithiasis , biliary strictures, primary sclerosing cholangitis (PSC), sphincter of Oddi dysfunction, and neoplasmssuch as cholangiocellular carcinoma.
Intraductal causes include choledocholithiasis , biliary strictures, Extraductal obstruction caused by external compression of the biliary
ducts may be secondary to neoplasms, such as pancreatic carcinoma, pancreatitis, or cystic duct stones with subsequent gallbladder distension.
Review lab studies to check
liver function
Review lab studies to check
liver function
total bilirubin 6.4 (normal, 0.3 to
1 mg/dL)
conjugated (direct) bilirubin
3.5 (normal, 0 to 0.2 mg/dL)
aspartate transaminase (AST) 128 (normal,
14 to 20 U/L)
albumin of 3.2 (normal, 3.5 to 4.8 g/dL)
alanine aminotransferase (ALT) 403 (normal, 10 to 40 U/L)
alkaline phosphatase (ALP) 269 (normal, 25 to 100 U/L)
prothrombin time 14.2 (normal, 11 to 13 seconds)
white blood cell count 11,000 cells/mm3
(normal, 4,500 to 10,500 cells/mm3
hematocrit 46% (normal, 42% to 52%)
platelets 222,000 cells/mm3(normal, 140,000 to 400,000 cells/mm3
A RELATIVELY COMMON disorder, biliary obstruction affects approximately 5 per 1,000 people. Jaundice is a key sign of biliary obstruction. The word icterus This article describes the various possible causes of biliary obstruction, diagnostic studies and treatment options, and nursing considerations for patients with this disorder.
Education can minimize risks，Before discharge, educate the patient about signs and symptoms to report immediately,。The patient should also be instructed to avoid alcohol and drugs that may interfere with normal coagulation, such as aspirin and ibuprofen.Unlike the ancients, we don’t have a “yellow bird” to cure our ailments. But with advancements in current diagnostic modalities and treatments, complications of biliary obstruction can be prevented