supervised by dr. jamal hamdi. definition of jaundice yellow pigmentation of skin, mucous membrane...
Post on 19-Dec-2015
220 views
TRANSCRIPT
![Page 1: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/1.jpg)
Surgical Jaundice
Supervised by Dr. Jamal Hamdi
![Page 2: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/2.jpg)
Definition Of Jaundice
• yellow pigmentation of skin, mucous membrane or
sclera
• Jaundice clinically detected when serum bilirubin level ( 2.5
mg/dl)
• Normal serum bilirubin (0.2-1.0 mg/dl )
• caused by an excess of bile
pigments in plasma• It is a symptom not a
disease
![Page 3: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/3.jpg)
Bilirubin Metabolism
Bilirubin is produced from the breakdown of haemoglobin in the reticuloendothelial system. 95% of the circulating bilirubin is unconjugated
and bound to albumin .
![Page 4: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/4.jpg)
Bilirubin Metabolism
RES
Hepatic metabolism occurs in 3 phases:
- Uptake - Conjugation - excretion
![Page 5: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/5.jpg)
Pathophysiology Of Hyperbilirubinemia
•Over production by RES
•Failure of hepatocellular uptake
•Failure of conjugation or excretion
•Obstruction of biliary excretion into intestine
![Page 6: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/6.jpg)
Classification Of Jaundice
Posthepatic(obstructed)
surgical
Hepatic :
•Congintal ( Gilberts Syndome , Criglar-Najjar Syndrome )
•Acquried ( Viral , Drugs , Alcohol , Wilson’s .. Etc )
Prehepatic:•RBC disorders• ( Hereditary spherocytosis , SCA) •Auto-immune ( Mismatched blood transfusion ) •Infective ( Sepsis , Malaria )
![Page 7: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/7.jpg)
Etiology Of Obstructive Jaundice
Common:
• Common bile duct stone.
• Cancer head of pancreas
![Page 8: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/8.jpg)
Etiology Of Obstructive Jaundice
Less Common:
•Ampullary carcinoma
• Pancreatitis.
•Mirrizi syndromes.
•Sclorosing cholangitis.
•Cholangiocarcinoma
![Page 9: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/9.jpg)
Approach To Jaundice Patient
History
Careful History is of very important value to guide the D\D toward the cause & the type of
jaundice
( PreHepatic , Hepatic , PostHepatic )
![Page 10: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/10.jpg)
Approach To Jaundice Patient
History
Onset
Sudden ?
CBD stone
Hepatitis
Gradual ?
cirrhosis pancreatitis
cancer
![Page 11: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/11.jpg)
Approach To Jaundice Patient
History
Pattern
fluctuating ? CBD stone
Ampullary carcinoma Hemolytic episodes
Progressive? Pancreatic carcinoma
Cholangiocarcinoma
![Page 12: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/12.jpg)
Approach To Jaundice Patient
History
Pain
painless?
Malignancy
Painful? CBD stone
Pancreatic diseases
![Page 13: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/13.jpg)
Approach To Jaundice Patient
History
Pruritis
Fatty dyspepsia
Steatorrhea
Dark urine , pale stool
Bleeding disorder
Other symptoms of obstructive jaundice
![Page 14: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/14.jpg)
Approach To Jaundice Patient
History
RUQ pain , fever
Symptoms of anemia
Hx of SCD
G6PD deficiency ? Food related ?
Symptoms of malignancy
( weight loss & anorexia )
![Page 15: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/15.jpg)
Approach To Jaundice Patient
History
Blood transfusion
Hx of drugs
Past Hx of surgery
Family Hx of jaundice & hemolytic disorders
Alcohol
Occupation & travel
Past Medical
Family Hx
Past Surgical Hx
![Page 16: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/16.jpg)
Approach To Jaundice Patient
Physical Examination
General Appearance
Cachexia
Muscle Wasting
Yellow Discoloration
Stigmata of Chronic Liver
Disease
Palmar erythema clubbing .
flapping tremor. duputrine’s
contracture . Spider nevi
gynecomastia caput medosa
testicular atrophy
General Examination
Jaundice
Scratch marks
Pallor
Vital Signs
![Page 17: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/17.jpg)
Approach To Jaundice Patient
Physical ExaminationAbdominal Discolration , scars
( collen’s , Grey Tuner )
RUQ pain
Murphy sign
Palpaple Gallbladder ( Courvoisier’s law )
Abdominal masses ( malignancy ) Hepatomegaly , splenomegaly ,
ascitis
PR : color of stool .
Abdominal Examination
![Page 18: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/18.jpg)
Obstructive Jaundice
Invistigation
InvasiveImagingLaboratory
Exam
![Page 19: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/19.jpg)
Obstructive Jaundice
Invistigation
Laboratory Exam Blood
LFT: Serum bilirubin (Direct / Indirect) , Albumin , ALT , AST , ALP, LDH ,
CBC , Electrolyte , Amylase
Urine
Urine analysis
Stool
The investigations will differentiate hepatocellular and obstructive jaundice
In most of the cases
![Page 20: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/20.jpg)
Obstruction Hepatitis CirrhosisBilirubin
Alk phos / /
ALT/AST/ /
gGT /
PT (INR)
Invistigation
![Page 21: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/21.jpg)
Obstructive Jaundice
Invistigation
ImagingNon-invasive
AXR
US
CT
MRI/MRCP
Invasive
ERCP
PTC
Operative cholangiogram
T-tube cholangiogram
Angiogram
Biopsy
![Page 22: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/22.jpg)
Obstructive Jaundice
Invistigation
Imaging
Non-invasive
1- The presence of gall stones 2- the thickened wall of the gallbladder in acute or chronic inflammation 3- The Diameter of CBD more than 7mm is suggestive of presence of stones
Is the most useful initial study for
evaluation of intra/extrahepatic biliary dilatation.
Ultrasounde
![Page 23: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/23.jpg)
Obstructive Jaundice
Invistigation
Imaging
Is the most useful initial study for
evaluation of intra/extrahepatic biliary dilatation.
Ultrasounde
![Page 24: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/24.jpg)
Obstructive Jaundice
Invistigation
Imaging
Non-invasive
Determine the specific causes and level of obstruction
CT scan can only image calcified stones
CT Scan
![Page 25: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/25.jpg)
Obstructive Jaundice
Invistigation
Imaging
CT Scan
![Page 26: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/26.jpg)
Obstructive Jaundice
Invistigation
Imaging
Non-invasive
Routine investigation-base-line & may
show specked calcification in the region of
pancreas.
X-Ray
![Page 27: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/27.jpg)
Obstructive Jaundice
Invistigation
Imaging
Non-invasive
Magnatic resonance cholangiopancreatography (MRCP)
Sensitive noninvasive method of detecting biliary and pancreatic duct stones
stricture or dilatations within the biliary system
MRCP
![Page 28: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/28.jpg)
Obstructive Jaundice
Invistigation
ImagingInvasive
Useful for lesion distal to the bifurcation of the hepatic ducts (diagnostic )
ERCP has a (therapeutic) application because obstruction can potentially be relieved by the removal of stones , sphcterotomy and placement of stent and drains
ERCP
![Page 29: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/29.jpg)
Obstructive Jaundice
Invistigation
Imaging
ERCP
![Page 30: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/30.jpg)
Obstructive Jaundice
Invistigation
Imaging
ERCP
![Page 31: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/31.jpg)
Obstructive Jaundice
Invistigation
ImagingInvasive
Percutaneous transhepatic cholangiogram (PTC )
Useful for lesions proximal to common hepatic duct
PTC
![Page 32: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/32.jpg)
Obstructive Jaundice
Treatment
According To The Cause
![Page 33: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/33.jpg)
Obstructive Jaundice
Treatment
• Relief of Obstruction
• Prevent Complication
• Prevent Recurrence
Goal of Treatment
![Page 34: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/34.jpg)
Obstructive Jaundice
Treatment
• Defined as stones in the CBD
•intermittent obstruction of CBD
•Predisposes to Cholangitis & Acute Pancreatitis
•Elevated sr. bilirubin & Alk. Phos.
•Evaluation By : U\S , ERCP , CT
Jaundice caused by Gallstones
![Page 35: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/35.jpg)
Obstructive Jaundice
Treatment
• Evaluation By : ERCP
•Primary diagnostic and therapeutic modality
•Sphincterotomy and stone extraction
•Placement of stent if stone extraction unsuccessful
• Mortality rate 1.5%
•ERCP
Jaundice caused by Gallstones
![Page 36: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/36.jpg)
Obstructive Jaundice
Treatment
Open CBD Exploration
Indications
•Presence of multiple stones (more than 5) Stones > 1 cm
• Multiple intra hepatic stones
•Distal bile duct strictures
• Failure of ERCP
• Recurrence of CBD stones after sphincterotomy
Jaundice caused by Gallstones
![Page 37: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/37.jpg)
Obstructive Jaundice
Treatment
CBD Exploration – Surgical Options
•Common bile duct exploration with T-tube decompression
• Choledochoduodenostomy
• Transduodenal sphincterotomy and sphincterplasty
•Roux-en-Y Choledocho jejunostomy
Jaundice caused by Gallstones
![Page 38: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/38.jpg)
Obstructive Jaundice
Treatment
At the time of diagnosis, 52% of all patients have distant disease
26% have regional spread.
The relative 1-year survival is only 24%
the overall 5-year survival rate for this disease is less than 5%.
Carcinoma Head Of Pancreas
![Page 39: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/39.jpg)
Obstructive Jaundice
Treatment
Surgical treatment
Carcinoma Head Of Pancreas
Non surgical treatment
(metal stents)
Non Resectabl
e
Resectable
![Page 40: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/40.jpg)
Obstructive Jaundice
Treatment
resectability. ?
Resectable, unresectable ?
experience and technical skill of the surgeon And overall health of the
patient
Typically, extrapancreatic disease precludes curative resection, and
surgical treatment may be palliative at best.
Carcinoma Head Of Pancreas
![Page 41: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/41.jpg)
Obstructive Jaundice
Treatment
Carcinoma Head Of Pancreas
![Page 42: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/42.jpg)
Obstructive Jaundice
Treatment
Carcinoma Head Of Pancreas
Non-resectable pancreatic head
tumor
![Page 43: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/43.jpg)
Obstructive Jaundice
Treatment
Non surgical treatment
Inoperable Patient :-
- Endoscopic expandable metallic stent
- Bypassed By Hepatojejunostomy
( Roux-en-Y)
Carcinoma Head Of Pancreas
![Page 44: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/44.jpg)
Obstructive Jaundice
Treatment
surgical treatment
Operable Patient :-
Whipple’s Operation
Pancreaticoduodenectomy
Curative ?
Carcinoma Head Of Pancreas
![Page 45: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/45.jpg)
Obstructive Jaundice
Treatment
Carcinoma Head Of Pancreas
Is It Curative ??
![Page 46: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/46.jpg)
Obstructive Jaundice
Treatment
Carcinoma Head Of Pancreas
Whipple’s Operation
![Page 47: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/47.jpg)
Obstructive Jaundice
Treatment
Carcinoma Head Of Pancreas
Whipple’s Operation
![Page 48: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/48.jpg)
Obstructive Jaundice
Treatment
Carcinoma Head Of Pancreas
Whipple’s Operation
![Page 49: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/49.jpg)
Traumatic stricture:-
by passed
Malignant stricture: -
resection with reconstruction by hepatico jejunostomy .
Sclerosing cholongitis:
Surgical excision
Per cuteneous dilation
Obstructive Jaundice
Treatment
Bile Duct Stricture
![Page 50: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/50.jpg)
•Ascending cholangitis
•Clotting disorders
•Hepato-renal syndrome
•Drug Metabolism
•Impaired wound healing
Obstructive Jaundice
Complications Of Obstructive
Jaundice
Be Aware Of life threatening Complications
![Page 51: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/51.jpg)
References
•Bailey & Love short practice of surgery
•Clinical Surgery By : A.Cuschieri
•Lecture Note : General Surgery 11th Edition
•http://www.radiologyassistant.nl/en/43848b63def9d
•http://emedicine.medscape.com/
![Page 52: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/52.jpg)
Done By
•Abbas A. Damanhori
•Abdulmajeed Fairaq
•Abdulrahman R. Nazer
•Hassan Abu Rokbah
![Page 53: Supervised by Dr. Jamal Hamdi. Definition Of Jaundice yellow pigmentation of skin, mucous membrane or sclera Jaundice clinically detected when serum bilirubin](https://reader035.vdocuments.us/reader035/viewer/2022062407/56649d2d5503460f94a03bd0/html5/thumbnails/53.jpg)