Biliary Tract: Obstructive Jaundice

Obstructive Jaundice

Hyperbilirubinemia/Jaundice

Obstructive Jaundice Presentation

  • Obstruction of Biliary Tract
  • Sx: Pale Stools, Dark Urine, Pruritus & Steatorrhea
  • Malabsorption of Fat-Soluble Vitamins
    • Vitamin A – Night Blindness
    • Vitamin D – Osteomalacia (Not Osteoporosis)
    • Vitamin E – Neuromuscular Weakness
    • Vitamin K – Coagulopathy

Causes

  • Cholestasis
  • Choledocholithiasis – Most Common Cause
  • Cholangiocarcinoma
  • Primary Sclerosing Cholangitis
  • Biliary Cyst
  • Parasitic Disease
  • Hemobilia
  • Biliary Atresia
  • Pancreatic Head Mass
  • Mirizzi Syndrome
  • Sphincter of Oddi Dysfunction
  • Periampullary Mass
  • Ampullary Stenosis

Rare Causes

Lemmel Syndrome

  • Definition: Obstructive Jaundice Caused by a Periampullary Duodenal Diverticulum Compressing the Intrapancreatic CBD
  • Tx: ERCP

Sump Syndrome

  • Definition: Food, Stones & Debris Obstruct the Distal CBD
  • Risk for Cholangitis
  • Complication After Side-to-Side Choledochoduodenostomy
    • Not Preferred Method of CBD Reconstruction
  • Tx: ERCP

Lemmel Syndrome 1

References

  1. Kang HS, Hyun JJ, Kim SY, Jung SW, Koo JS, Yim HJ, Lee SW. Lemmel’s syndrome, an unusual cause of abdominal pain and jaundice by impacted intradiverticular enterolith: case report. J Korean Med Sci. 2014 Jun;29(6):874-8. (License: CC BY-NC-3.0)