1 / 14

Obstructive jaundice

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?

adamdaniel
Télécharger la présentation

Obstructive jaundice

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Obstructive jaundice I C Cameron

  2. 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

  3. 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

  4. 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?

  5. ERCP • 1st attempt failed, oedematous papilla • Bilirubin continues to rise • Next move?

  6. 2nd ERCP • No deep cannulation, cholangiogram • Short stricture distal CBD stricture • PD normal • What next?

  7. Patient becomes very unwell • Pain, pyrexia, amylase 1370 • IVI, catherterised, inotropes, HDU • 3 days: bilirubin increased, much better • Priority?

  8. Drain biliary system • PTC and external drain • CT scan + Transfer

  9. RHH management • Repeat PTC and internalise stent • Bilirubin falling • CT review – inflammatory mass centred around HOP, stranding in soft tissue • Conservative treatment • Next step?

  10. Repeat CT • 8 weeks later repeat CT – infl change better • 2 weeks later – exploratory laparotomy • Inflammatory mass involving HOP, stomach, duodenum , TC • No procedure

  11. Clinic follow up • Probable distal CBD cholangiocarcinoma • Never well enough for chemotherapy • Deceased 7 months later

  12. 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

More Related