obstructive jaundice


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jaundice

 [jawn´dis]
yellowness of skin, sclerae, mucous membranes, and excretions due to hyperbilirubinemia and deposition of bile pigments. It is usually first noticeable in the eyes, although it may come on so gradually that it is not immediately noticed by those in daily contact with the jaundiced person. Called also icterus.

Jaundice is not a disease; it is a symptom of a number of different diseases and disorders of the liver and gallbladder and of hemolytic blood disorders. One such disorder is the presence of a gallstone in the common bile duct, which carries bile from the liver to the intestine. This may obstruct the flow of bile, causing it to accumulate and enter the bloodstream. The obstruction of bile flow may cause bile to enter the urine, making it dark in color, and also decrease the bile in the stool, making it light and clay-colored. This condition requires surgery to remove the gallstone before it causes serious liver injury.

The pigment causing jaundice is called bilirubin. It is derived from hemoglobin that is released when erythrocytes are hemolyzed and therefore is constantly being formed and introduced into the blood as worn-out or defective erythrocytes are destroyed by the body. Normally the liver cells absorb the bilirubin and secrete it along with other bile constituents. If the liver is diseased, or if the flow of bile is obstructed, or if destruction of erythrocytes is excessive, the bilirubin accumulates in the blood and eventually will produce jaundice. Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected.
Patient Care. Assessment of the patient with jaundice includes observations of the degree and location of yellowing, noting the color of urine and stools, and the presence of itching. Since jaundice can be accompanied by severe itching, frequent skin care is important to preserve skin integrity. Tepid sponge baths can help reduce discomfort and promote rest.

Patients with severe jaundice are at risk for encephalopathic changes that produce confusion, impaired mentation, and altered levels of consciousness. The potential for injury is increased and demands vigilance and safety measures to protect the patient.
Jaundice may be attributable to prehepatic (A), hepatic (B), or posthepatic (C) causes. From Damjanov, 2000.
acholuric jaundice jaundice without bilirubinemia, associated with elevated unconjugated bilirubin that is not excreted by the kidney. Familial acholuric jaundice is another name for the hereditary form of hemolytic jaundice.
breast milk jaundice elevated unconjugated bilirubin in some breast-fed infants due to the presence of an abnormal pregnane that inhibits glucuronyl transferase conjugating activity.
cholestatic jaundice that resulting from abnormality of bile flow in the liver.
familial nonhemolytic jaundice Gilbert disease.
hematogenous jaundice hemolytic jaundice.
hemolytic jaundice see hemolytic jaundice.
hepatocellular jaundice jaundice caused by injury to or disease of the liver cells.
leptospiral jaundice Weil's syndrome.
neonatal jaundice (jaundice of the newborn) icterus neonatorum.
nonhemolytic jaundice that due to an abnor-mality in bilirubin metabolism.
obstructive jaundice that due to blockage of the flow of bile.
physiologic jaundice mild icterus neonatorum during the first few days after birth.

ob·struc·tive jaun·dice

jaundice resulting from obstruction to the flow of bile into the duodenum, whether intrahepatic or extrahepatic.
Synonym(s): mechanical jaundice

obstructive jaundice

obstructive jaundice

Hepatology Jaundice due to obstruction of the flow of bile through the cystic duct into the ampulla of Vater and thence into the small intestine. See Jaundice.

ob·struc·tive jaun·dice

(ŏb-strŭk'tiv jawn'dis)
Hepatic disorder resulting from obstruction to the flow of bile into the duodenum, whether intra- or extrahepatic.
Synonym(s): mechanical jaundice.

obstructive jaundice

JAUNDICE caused by any process in the liver or bile ducts that prevents the normal outflow of bile. Obstructive jaundice is commonly caused by GALLSTONES (large duct obstruction) or a cancer of the head of the PANCREAS, or by disease processes that occlude the small bile ducts within the liver, such as HEPATITIS and CIRRHOSIS (small duct obstruction). Unrelieved obstruction causes ever-deepening jaundice.

ob·struc·tive jaun·dice

(ŏb-strŭk'tiv jawn'dis)
Hepatic disorder resulting from obstruction to the flow of bile into the duodenum, whether intra- or extrahepatic.
Synonym(s): mechanical jaundice.

jaundice

yellowness of skin, sclerae, mucous membranes, and excretions due to hyperbilirubinemia and deposition of bile pigments. Called also icterus. It is usually first noticeable in the sclera.
The pigment causing jaundice is called bilirubin. It is derived from hemoglobin that is released when erythrocytes are hemolyzed and therefore is constantly being formed and introduced into the blood as worn-out or defective erythrocytes are destroyed by the body. Normally the liver cells absorb the bilirubin and secrete it along with other bile constituents. If the liver is diseased, or if the flow of bile is obstructed, or if destruction of erythrocytes is excessive, the bilirubin accumulates in the blood and eventually will produce jaundice. Determination of the level of bilirubin in the blood is of value in detecting elevated bilirubin levels at the earliest stages before jaundice appears, when liver disease or hemolytic anemia is suspected.
Enlarge picture
Jaundice in a horse's oral mucosa. By permission from Knottenbelt DC, Pascoe RR, Diseases and Disorders of the Horse, Saunders, 2003

acholuric jaundice
jaundice without bilirubinemia, associated with elevated unconjugated bilirubin that is not excreted by the kidney.
cholestatic jaundice
that resulting from abnormality of bile flow in the liver.
hematogenous jaundice
hemolytic jaundice.
hemolytic jaundice
jaundice associated with hemolytic anemia in which most of the bilirubin is unconjugated. Called also retention jaundice, prehepatic jaundice.
hemorrhagic jaundice
leptospirosis.
hepatocellular jaundice
jaundice caused by injury to or disease of the liver cells.
jaundice index
see icteric index.
nonhemolytic jaundice
that due to an abnormality in bilirubin metabolism.
obstructive jaundice
that due to blockage of the flow of bile, resulting in conjugated hyperbilirubinemia. Called also regurgitation jaundice.
physiological jaundice
mild icterus neonatorum during the first few days after birth.
regurgitation jaundice
obstructive jaundice (above).
toxic jaundice
see hepatocellular jaundice (above).
References in periodicals archive ?
Metastatic colorectal cancer can cause obstructive jaundice by lymph node metastases along the common bile duct or in the porta hepatis, (6,9) bile duct metastases, (6,14) or floating tumor inside the bile duct.
Many are incidental but occasionally do present with obstructive jaundice (1).
Pseudocyst formation in chronic pancreatitis; a cause of obstructive jaundice.
Modulation of immunosuppression in obstructive jaundice by Tinospora cordifolia.
A lipoprotein characterizing obstructive jaundice, II: isolation and partial characterization of the protein moieties of low density lipoproteins.
Hepatocellular carcinoma may present with hepatic decompensation or obstructive jaundice (8).
5) Obstructive jaundice is an infrequent association with HCs.
The principal clinical task is to distinguish obstructive jaundice from jaundice due to parenchymal liver disease.
The most common indications for abdominal CT at our institution include: obstructive jaundice, pancreatitis, complicated renal cysts and liver lesions--all upper-abdominal pathology.
5) These observations were followed by experimental evidence suggesting that protein enriched peritoneal dialysis increases the clearance of bilirubin in rats suffering from obstructive jaundice.
Apart from abnormal liver function tests (LFTs) suggestive of obstructive jaundice, CA 19-9 level was significantly elevated at 4,374 U/mL.
Patients may present with abdominal pain, obstructive jaundice, and cholangitis.

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