Pathologies of the liver, which are caused by partial or complete blockage of the bile ducts, are quite common. Their symptoms are usually a yellow color of the skin and mucous membranes. And this condition is called obstructive jaundice. Description, symptoms, signs and treatment of it, we will consider in this article.
Causes of occurrence
Previously, obstructive jaundice (ICD-10 code - K83.1) was perceived as an independent disease, but numerous studies have proven that this is only a symptom. It is caused by disorders in the hepatobiliary tract and the formation of bile calculi. In the registry of the international classification of diseases (ICD-10 code - K83.1), obstruction of the bile ducts is called obstruction of the bile ducts. Its other names are subhepatic or obstructive jaundice.
The main cause of the development of the syndrome is recognized as compression or closure of the duct, whichinterrupts the flow of bile into the intestines. And most often the named phenomenon is caused by the following pathologies:
- The formation of stones in the hepatobiliary tract as a result of biliary stagnation, that is, cholestasis, or an increase in the s alt content in bile as a result of a failure in metabolic processes.
- Development of cholangitis, pancreatitis, cholecystitis, etc.
- Tumors and cysts in the bile ducts, pancreas or gallbladder and other oncological neoplasms.
- Intestinal diverticula, biliary atresia and other developmental anomalies. Often obstructive jaundice is associated with these diseases in newborn babies.
- Infection with parasites, including echinococcus and roundworm.
- Obstructive jaundice (ICD-10 code - K83.1., as already indicated) in a chronic form can be a sign of cancer in the head of the pancreas.
But Klatskin's tumor, or cholangiocarcinoma, is accompanied by this disease only when it reaches a large size.
Signs of disease
The main symptom of obstructive jaundice (the ICD-10 code has already been indicated earlier) is the yellowing of all tissues in the body, including the whites of the eyes and mucous membranes. This phenomenon is due to an increased concentration of bilirubin. Its other signs are:
- Biliary colic. Characterized by sharp bouts of pain in the upper right abdomen. The pain radiates to the right shoulder, shoulder blade or collarbone and is usually due toexercise, eating fried or fatty foods, or drinking alcoholic beverages.
- Liver enlargement, or hepatomegaly.
- Increased body temperature.
- Nausea and vomiting of bile.
- Itchy skin.
- Light colored stools and dark urine.
Symptoms
Jaundice can also occur as a consequence of another disease that invariably accompanies cholestasis. The symptoms are:
- Dyspeptic syndrome, which is characterized by nausea and heaviness in the epigastric region.
- Courvoisier's symptom, when the enlargement of the gallbladder is obvious even on palpation due to its overflowing with bile. There is no pain on palpation.
- Abnormal weight loss.
Chronic form
In chronic form, obstructive jaundice causes anxiety in the right side, in the hypochondrium region. The pain is aching and dull, aggravated by vibration, bending over and during heavy lifting.
Nausea with jaundice is constant, worse after eating fatty foods and alcoholic beverages. In addition, this condition is characterized by weakness, fatigue and dizziness, which are signs of asthenic syndrome.
Next, we will find out what complicates mechanical conjugative jaundice (ICD-10 code - P59).
Complications
Regardless of what causes malfunctions in the process of outflow of bile, thiscan cause cirrhosis. This disease is characterized by the formation of nodes in the liver, which consist of connective fibrous tissue. This pathology develops as a result of the death of active hepatocytes. In the future, cirrhosis risks developing into liver failure and dysfunction.
Another complication of unspecified obstructive jaundice (ICD diagnosis code - R17) is intoxication with metabolic products that are not properly excreted from the body, being absorbed from the intestines into the bloodstream. This disease is called toxemia. First of all, the tissues of the kidneys and liver are affected, which ultimately leads to failure of these organs.
When toxins enter the brain, hepatic encephalopathy occurs, which typically affects the entire nervous system. This occurs as a consequence of a breach in the blood-brain barrier.
Cholecystitis, cholangitis and other bacterial infections can also accompany obstructive jaundice. Lack of timely therapy and generalization of the process can create a risk of septic shock.
Note that different types of jaundice have similar symptoms, and this can complicate diagnosis. So, hemolytic jaundice is characterized by increased breakdown of red blood cells and excessive production of hemoglobin, which is transformed into bilirubin. And parenchymal jaundice is characterized by an inflammatory process in the tissues of the liver.
When diagnosing, in addition to external signs, special attention is paid to the resultsstudies, specifically bilirubin fractions (direct or indirect) and enzyme levels.
Newborn jaundice
ICD-10 code - P59 - refers to unspecified neonatal jaundice that affects newborns. It is physiological and pathological. The first of them manifests itself in the first week of the baby's life and after some time passes on its own. But sometimes it can be a symptom of an underlying medical condition.
In newborns, a violation of the process of metabolism of the enzyme bilirubin is possible. This leads to pathological pigmentation of the mucous membranes and skin.
If jaundice is of a physiological form, then this does not affect the well-being, appetite, sleep and wakefulness of the child. In the case of a pathological form of the disease, the clinical picture is supplemented by the following symptoms:
- The baby develops significant yellowness of the skin and sclera.
- He is sleepy and sluggish.
- Refused to feed.
- Temperature increased.
- Crying often, while throwing back his head, arching his body.
- There is profuse vomiting.
- Convulsions.
How obstructive jaundice is treated, we will consider below.
Diagnosis
One should not underestimate instrumental and laboratory research methods in the diagnosis of obstructive jaundice, the ICD-10 code of which is indicated in the article. After all, only they can help to find out the true causes of the development of this syndrome. The prognosis for recovery depends on the timeliness of the placement of the patient insurgery department. To identify the causes of obstructive jaundice, the following diagnostic methods are used:
- Complete blood count. If anemia is detected, which is characterized by a decrease in the level of hemoglobin and red blood cells, this indicates a chronic form of the disease. An increase in ESR and leukocytosis indicates the presence of an inflammatory process.
- Blood test for biochemistry. In this case, attention is paid to an abnormal increase in the level of ALT, AST, gamma-glutamyl transferase, alkaline phosphatase, cholesterol, etc. This type of study also reveals the advantage of the direct fraction of bilirubin in relation to the indirect one.
- Computed tomography and ultrasound examination of the abdominal cavity can help determine the size and structure of the gallbladder and liver, detect the presence of gallstones, and assess blood flow and cholestasis.
- Esophagogastroduodenoscopy. It is an examination of the organs of the gastrointestinal tract through an endoscope. The latter is a flexible optical tube and helps to detect the existing pathology.
- Magnetic resonance cholangiopancreatography. It is carried out by introducing a contrast fluid, which allows visualization of the bile ducts.
- Scintigraphy. During the study, radiopharmaceuticals are distributed to the tissues, which are controlled according to the established time parameters.
- Laparoscopy and biopsy. Sampling of material from the tumor for further research andcytology.
Mechanical jaundice: prognosis and treatment
What is it, discussed earlier. Now it is worth learning about the methods of treating the disease. The presence of obstructive jaundice requires immediate medical intervention, regardless of whether it manifested itself in a child or in an adult patient. The first goal of therapy is to eliminate biliary stagnation. This is achieved through the use of drug treatment with the following drugs:
- hepatoprotectors, which include B vitamins, ursodeoxycholic acid, Gepabene, Essentiale, Silymarin, etc.;
- Pentoxyl, which helps stimulate metabolic processes;
- amino acids such as methionine and glutamic acid;
- hormonal drugs, including Prednisolone;
- drugs "Neorondex", "Rheosorbilact" and "Rheopolyglukin", stimulating blood circulation in the liver.
If a secondary infectious disease is added, antibacterial therapy is carried out with drugs such as Imipenem, Ampicillin, etc.
Operation
Patients diagnosed with cholestasis often require surgery. But icteric syndrome is a contraindication for such measures, as it is considered a great risk to the life and he alth of the patient. Therefore, at the initial stage of the disease, the pressure in the bile ducts is reduced by the endoscopic method. Lithotripsy is also allowed.
The next step is to install a stent or anastomoses. These measures are aimed at dilating the bile duct and removing the accumulated substance.
Complete removal of the gallbladder is prescribed for patients who have chronic or acute calculous cholecystitis. This surgical intervention does not pass without a trace for the state of the body. Complications after surgery can be vomiting, nausea, pain on the right side. In this case, it is recommended to observe the sleep and work regimen, adhere to proper nutrition and take antispasmodic drugs and hepatoprotectors. Sometimes enzyme therapy, such as Pancreatin, may be prescribed.
Diet
Absolutely everyone who has had obstructive jaundice is recommended to follow certain nutritional principles, to give up fried, fatty and spicy foods, and the use of alcoholic beverages. It is necessary to eat fractionally, in small portions. Intense loads should be excluded. Therapy of obstructive jaundice is a complex and lengthy process in which the main thing is patience and adherence to all the advice of a specialist.
We hope that the information presented in the article about obstructive jaundice, treatment, diagnosis and causes of this disease will be useful to you.
