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INTRODUCTION. DEFINITIONEPIDEMIOLOGYAETIOLOGYPATHOGENESISCLINICAL FEATURESMANAGEMENTCOMPLICATIONSPROGNOSIS. DEFINITION . DEFINE JAUNDICETYPES OF JAUNDICE- CLASSIFYWITH RESPECT TO THE PATHOGENESIS- THE LIVER IS CENTRALPRE-HEPATIC, HEPATIC, POST-HEPATICOBSTRUCTIVE JAUNDICEAMENABLE/TREATABL
 
                
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1. SURGICAL JAUNDICE Dr. ADEFEMI O. AFOLABI
HEPATOBILIARY & ENDOCRINE DIVISION
DEPARTMENT OF SURGERY
COLLEGE OF MEDICINE
UNIVERSITY OF IBADAN,
& 
UNVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA.
 
2. INTRODUCTION DEFINITION
EPIDEMIOLOGY
AETIOLOGY
PATHOGENESIS
CLINICAL FEATURES
MANAGEMENT
COMPLICATIONS
PROGNOSIS 
3. DEFINITION DEFINE JAUNDICE
TYPES OF JAUNDICE- CLASSIFY
WITH RESPECT TO THE PATHOGENESIS- THE LIVER IS CENTRAL
PRE-HEPATIC, HEPATIC, POST-HEPATIC
OBSTRUCTIVE JAUNDICE
AMENABLE/TREATABLE BY SURGERY 
4. EPIDEMIOLOGY DISTRIBUTION
GEOGRAPHICAL
AGE
GENDER 
5. AETIOLOGY AGE
GENDER
GEOGRAPHICAL
LUMEN- INTRA-, MURAL, EXTRA-
PNEMONIC- TINCABED 
6. AETIOLOGY CHOLEDOCHOLITHIASIS
CHOLEDOCHAL CYST
BILIARY ATRESIA & OTHER BILIARY ANATOMICAL VARIATIONS
 
7. AETIOLOGY NEOPLASMS- CARCINOMA, HEAD OF PANCREAS, CHOLANGIOCARCINOMA,
  PERIAMPULLARY CARCINOMA, CARCINOMA OF THE DUODENUM
LYMPHADENOPATHY-PORTA HEPATIS 
TRAUMATIC- POST CHOLECYSECTOMY 
8. PATHOGENESIS AETIOLOGICAL FACTORS-CALCULOUS, NEOPLASTIC
BILIARY TREE OBSTRUCTION
STASIS
HEPATOCELLULAR DYSFUNCTION
CHOLANGITIS
MALABSORPTION
 
9. CLINICAL FEATURES WITH RESPECT TO AETIOLOGY &
 THE EFFECTS OF OBSTRUCTION
JAUNDICE, PRURITUS, DARK URINE, PALE STOOLS, PAIN/COLIC, WEIGHT LOSS, VOMITING, ANOREXIA, ANAEMIA, ABDOMINAL MASS, HEPATOMEGALY, GALL BLADDER DISTENSION, ASCITES 
10. MANAGEMENT CONFIRM CLINICAL DIAGNOSIS
ASSESS PHYSIOLOGICAL STATUS
INVESTIGATE FOR SURGERY 
11. INVESTIGATIONS ABDOMINAL ULTRASOUND
ABDOMINAL CT SCAN
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATO-
  -GRAPHY 
12. INVESTIGATIONS SERUM BILIRUBIN, ALKALINE PHOSPHATASE, AST, ALT, ALBUMIN, GLOBULIN, CHOLESTEROL
PROTHOMBIN TIME (INR), PTTK
URINALYSIS, SERUM E/U& Cr.,
 
13. CT ABDOMEN 
14. CT ABDOMEN 
15. DISTENDED GALL BLADDER 
16. BILIARY BYPASS 
17. CT ABDOMEN(DA)  
18. LUNG METASTASES OF GALL BLADDER CANCER 
19. INVESTIGATIONS FULL BLOOD COUNT, GROUP & CROSS MATCH BLOOD
HAEMOGLOBIN ELECTROPHORESIS
BLOOD CULTURE
CHEST X-RAY, ABDOMINAL X-RAY
TRANSHEPATIC CHOLANGIOGRAPHY 
20. TREATMENT OPTIMISE THE PATIENT-CORRECT ANAEMIA, ELECTROLYTE ABNORMALITIES, REHYDRATE, BLEEDING DISORDER(VITAMIN K), NUTRITION-CHO, PROTEIN, 
BOWEL PREPARATION, PERIOPERATIVE ANTIBIOTICS 
21.  TREATMENT CHOLEDOCHOLITHIASIS- 
   INTRAOPERATIVE CHOLANGIGRAPHY
   CHOLECYSTECTOMY- 
         OPEN/LAPAROSCOPIC, 
   EXPLORATION OF COMMON BILE DUCT, INSERTION OF T-TUBE-MANAGEMENT OF TUBE,
   ENDOSCOPIC SPHINCTEROTOMY
CARCINOMA- WHIPPLES PROCEDURE,  
22. T-TUBE CHOLANGIOGRAM 
23. PALLIATIVE TREATMENT ENDOSCOPIC INSERTION OF BILIARY STENT
BYPASS SURGERY
   CHOLECYSTOJEJUNOSTOMY OR  CHOLEDOCHOJEJUNOSTOMY,GASTROJEJUNOSTOMY, & JEJUNOJEJUNOSTOMY-SIDE TO SIDE OR ROUX-EN-Y 
24. COMPLICATIONS OF TREATMENT BLEEDING
SEPTICAEMIA
RENAL FAILURE
ANASTOMOTIC DEHISCENCE
OTHERS 
25. PROGNOSIS DEPENDS ON THE AETIOLOGY AND THE STAGE OF PRESENTATION 
26. CONCLUSIONS   
   DO IT RIGHT THE FIRST TIME, BECAUSE LIFE IS NOT A DRESS REHEARSAL
                             BOB GASS