Obstructive jaundice is a disease in which there is a failure in the outflow of bile from the liver through the bile ducts into the duodenum. The cause of this syndrome is the presence of mechanical obstructions in the bile ducts. Sometimes this disease is called subhepatic, obstructive, acholic or resorption jaundice, as well as extrahepatic cholestasis.
Mechanical blockage of the bile ducts is not considered an independent disease and manifests itself as a complication of pathologies of the pancreas and biliary system.
Description
Mechanical jaundice (ICD K83.1) is manifested by the acquisition of a yellowish skin, dark urine, itching and pain in the abdomen, and discoloration of stool.
Progressive jaundice can lead to complications such as kidney and liver failure, sepsis, purulent cholangitis, biliary cirrhosis, and especiallyadvanced cases, if obstructive jaundice is not treated, even fatal.
The most common causes of pathology are malignant neoplasms and cholelithiasis. Basically, this type of jaundice appears in patients older than 30 years. Most often, the disease affects women, but malignant neoplasms of the biliary tract are common for the most part among the male population.
Causes of icteric syndrome
Prerequisites for the occurrence of obstructive jaundice as a result of abnormal functioning of the biliary tract are well studied by medicine. Depending on the origin of the disease, 5 groups of factors leading to its appearance are distinguished:
- Genetic abnormalities in the development of the biliary system, it can be atresia or hypoplasia of the biliary tract.
- Changes in the biliary system and pancreas of a benign nature. The cause of this phenomenon is often cholelithiasis, which provokes the appearance of formations in the form of stones in the bile ducts, protrusion of the walls of the duodenum, stenosis of the major duodenal papilla, the structure of the ducts in the form of scars, chronic indurative pancreatitis, cysts and sclerosing cholangitis.
- Another cause of obstructive jaundice is the postoperative formation of strictures of the main bile ducts. Strictures are formed as a result of accidental damage to the ducts during surgery or incorrect suturing.
- Malignant formations in the organs of the pancreato-hepatobiliaryprimary or secondary systems. These include pancreatic head cancer, gallbladder cancer, liver metastasis from gastric cancer, and Hodgkin's disease.
- Parasitic infection of the biliary tract and liver, such as echinococcal cyst, alveococcosis, etc.
Tumor formations are the most common cause of obstructive jaundice (ICD K83.1). Cholelithiasis is also not inferior in frequency. Other diseases that can lead to icteric syndrome are much less common. Rarely, acute appendicitis and duodenal ulcer lead to the appearance of obstructive jaundice (ICD code 10 K83.1).
Cholestasis
Cholestasis develops against the background of the movement of stones from the gallbladder into the ducts. In the ducts, stones are formed much less frequently. As a rule, they pass into the common bile duct from the bladder as a result of hepatic colic. A blockage occurs when a large stone cannot pass through the bile duct. Spasm of the sphincter of Oddi can lead to the fact that even a small stone cannot pass through the bile duct. The case history of obstructive jaundice is reviewed in detail.
A fifth of all patients with gallstone disease are also diagnosed with the presence of stones. The icteric syndrome with cholestasis resolves on its own after the therapy of the disease itself is carried out. That is, when the stones pass into the intestinal area, the jaundice disappears.
Malignant formations in the pancreato-hepatobiliary zone are found in a third of all cases of icteric syndrome. Most often it is cancer of the head of the pancreas and neoplasms in the gallbladder and main bile ducts.
Signs of pathology
Common symptoms of obstructive jaundice are:
- Pain in the subcostal and epigastric regions, which are dull in nature and tend to gradually increase.
- Darkening of the color of urine and discoloration of stools, as well as diarrhea.
- The color of the skin is yellowish, gradually turning into earthy. With obstructive jaundice, bilirubin is significantly increased.
- Itchy skin.
- Nausea and vomiting.
- Abnormal weight loss.
- Lack of appetite.
- Increased body temperature.
- Cholesterol deposits in the area of the eyelids in the form of formations with clear edges.
- Liver enlargement.
Kind of pain
Pain in the blockage of bile ducts by calculi is spasmodic, sharp, radiates to the chest area, scapula and armpit on the right. A few days after the decrease in the intensity of hepatic colic, external symptoms of icteric syndrome appear. The area of the liver is painful on palpation. It is not possible to feel the gallbladder. If you press on the right hypochondrium, then you involuntarily hold your breath.
Oncology
If the cause of obstructive jaundice is a malignant neoplasm in the pancreas, pain appears in the epigastric region andgiven to the back area. The gallbladder is distended and causes pain on palpation. The liver acquires a dense or elastic consistency, increased in size, and also has a nodular structure. The spleen is not palpable. The icteric syndrome is preceded by lack of appetite and itching of the skin.
An increase in the size of the liver is a common symptom in the disease of obstructive jaundice. This is due to the overflow of the liver with bile, as well as the inflammatory process in the biliary tract.
Itching of the skin can occur long before the onset of all other symptoms of jaundice. Itching is not amenable to medical treatment, severe and debilitating. In places of scratching, hematomas appear. Cancer diseases and, as a result, jaundice are often accompanied by unmotivated weight loss.
Fever is due to infection of the biliary tract. If the temperature is elevated for a long period, this is a sign of subhepatic jaundice, and not viral hepatitis, with which it is often confused at the initial stage.
Diagnosis of obstructive jaundice
In the case of a well-palpable tumor, the diagnosis is not particularly difficult. At the initial stage, however, cholestasis manifests itself in the same way as many other similar diseases. Therefore, making a correct diagnosis can be quite difficult.
Laboratory techniques are poorly suited to diagnose obstructive jaundice at an early stage. Elevated levels of bilirubin and cholesterol, as well as highalkaline phosphatase activity can indicate both intrahepatic cholestasis and viral hepatitis.
In connection with the above, instrumental methods play a decisive role in the diagnosis of obstructive jaundice (ICD code). The most commonly used techniques are:
- Sound examination. This method allows you to identify the presence of stones, as well as the degree of expansion of the bile ducts and liver damage. In most cases, ultrasound helps to determine the presence of stones in the gallbladder, somewhat less often they can be identified in the terminal part of the bile duct. Quite rarely, but there were cases when it was not possible to differentiate a tumor formation from an accumulation of calculi in the gallbladder.
- Duodenography of relaxation type. In fact, this is an x-ray of the duodenum, however, the study is carried out under the conditions of creating artificial hypotension of the organ. This method is used to detect metastases in the duodenum in pancreatic cancer.
- Endoscopic retrograde cholangiopancreatography. It is used in cases where ultrasound is not enough, especially if blockade of the major duodenal papilla is suspected. A special contrast agent is injected into the duct, and then several x-rays are taken using a special tube. This method allows diagnosing even small tumor formations with high accuracy, taking material from the duct for histology. This type of research is invasive, so its use is associated witha certain risk of complications.
- Percutaneous transhepatic cholangiography. This procedure is prescribed in case of blockage of the biliary tract to the liver. Before the start of the study, local anesthesia is performed, after which, under ultrasound control, a thin needle with a contrast agent is inserted into one of the hepatic ducts. This method is dangerous with a large number of potential complications, including internal bleeding, peritonitis and bile leakage.
- Radioisotope liver scan. The method is used to diagnose malignant neoplasms and parasitic invasions of the liver. This study is carried out in cases where there is no other way to determine the presence of a mechanical obstruction in the biliary tract.
- Laparoscopic examination. This is the most invasive method of all of the above. It is used in cases where other methods were ineffective and did not allow clarifying the diagnosis. Laparoscopy is performed to identify metastatic cells, as well as to determine the extent of liver damage.
Treatment
Treatment of obstructive jaundice is primarily to eliminate the root cause of the appearance of such symptoms. For this, a special diet is observed, as well as conservative drug treatment. It consists in the intravenous administration of a glucose solution, various B vitamins, as well as drugs such as:
- Essentiale. Stimulates the process of blood circulation in the liver.
- "Vikasol". Prevents bleeding.
- "Trental". Contains glutamic acid.
- Antibiotic drugs.
In addition, plasmapheresis is used, which cleanses the blood and enterosorption, aimed at ridding the body of toxins. Obstructive jaundice in surgery is also treated.
Surgery
Depending on the nature of the disease, as well as in cases where conservative methods fail, various types of surgical intervention are used, consisting of the following manipulations:
- External drainage of the bile ducts. The operation is aimed at restoring the outflow of bile in case of blockage of the biliary system. This method is carried out in a planned manner, as it is minimally invasive.
- Endoscopic cholecystectomy. It consists in removing the gallbladder through an endoscopic opening.
- Endoscopic papillosphincterotomy. Performed to remove stones that have accumulated in the gallbladder.
- Choledocholithotomy. It is carried out simultaneously with the removal of the gallbladder. During the operation, formations in the form of stones are removed from the bile ducts.
- Partial hepatectomy. It is carried out to remove those liver tissues that have been affected, for example, by a malignant neoplasm.
Food
It is very important for obstructive jaundice (ICD 10 K83.1) to have proper therapeutic nutrition. Before surgery, the diet is aimed at reducingstress on hepatic cells. In the postoperative period, the goal of a therapeutic diet is to accelerate the recovery process of the body as a whole.
It is necessary to observe the drinking regime and drink at least two liters of liquid. Such a measure will speed up the process of removing bilirubin and reduce the burden on the central nervous system, lungs and kidneys.
In the daily diet of patients with jaundice should include more carbohydrates, including in the form of drinks. These can be compotes, sweet teas, glucose solutions, etc. This will restore the energy supply in the body and speed up metabolic processes. The prognosis for obstructive jaundice depends on the reason for which it arose.
This question does not have a clear answer. If the patient does not receive qualified assistance in time, then the possibility of death is not ruled out. If you follow all the stages of treatment, then a quick recovery will come. The prognosis for oncology is unfavorable most often. Since there is a dangerous effect not only on the tumor, but also on its metastases, spreading throughout the body. With the help of timely therapy in the early stages of cancer, it is possible to stop the disease. And modern methods of therapy for cancer patients alleviate the patient's condition in the later stages.
After the operation, the patient's menu becomes more diverse, gradually it includes cereals with milk, juices, vegetable soups, etc. All food taken should be mashed and not hot. If the food is normally perceived by the body,the diet is supplemented with lean fish and steamed meat. A small amount of butter or vegetable oil is allowed. Animal fats, however, are greatly restricted, as are spices. After the patient's condition is fully stabilized, he is allowed to eat stale bread and low-fat dairy products.
