By obstructive jaundice is meant a disease in which there is a failure in the outflow of bile from the liver through the bile ducts to the duodenum. The cause of this syndrome is the presence of mechanical obstruction 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 is manifested as a complication of pathologies of the pancreas and biliary system.
Description
Obstructive jaundice (ICD K83.1) is manifested by the acquisition of a yellowish skin, dark urine, itching and pain in the abdomen, as well as discoloration of feces.
Progressive jaundice can lead to complications such as renal and hepatic insufficiency, sepsis, purulent cholangitis, biliary cirrhosis, and in especially neglected cases if mechanical jaundice is not treated, even fatal.
The most common causes of the development of pathology are malignant neoplasms and gallstone disease. Basically, this type of jaundice appears in patients older than 30 years. Most often, the disease affects women, however, malignant neoplasms of the biliary tract are common mostly among the male population.
Causes of icteric syndrome
The prerequisites for the occurrence of obstructive jaundice as a result of the abnormal functioning of the biliary tract are well studied by medicine. Depending on the origin of the disease, 5 groups of factors are identified that lead to its appearance:
- 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 large duodenal papilla, duct structure in the form of scars, chronic pancreatitis of an inductive form, 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-hepatobiliary system of the primary or secondary type. These include pancreatic head cancer, gall bladder cancer, liver metastasis as a result of stomach cancer and lymphogranulomatosis.
- Parasitic infection of the biliary tract and liver, such as echinococcal cyst, alveococcosis, etc.
Tumor masses are the most common cause of obstructive jaundice (ICD K83.1). Gallstone disease is not inferior in frequency either. Other diseases that can lead to icteric syndrome are much less common. Rarely, obstructive jaundice (code according to ICD 10 K83.1) is caused by acute appendicitis and a duodenal ulcer.
Cholestasis
Cholestasis develops against the background of the movement of calculi from the gallbladder to the ducts. In the ducts, calculi are formed much less frequently. As a rule, they pass into the common bile duct from the bladder as a result of hepatic colic. Blockage occurs if the large-sized stone cannot cross the bile duct. A spasm of the sphincter of Oddi can lead to the fact that even a small stone cannot pass through the bile duct. The history of obstructive jaundice is examined in detail.
One fifth of all patients with gallstone disease are also diagnosed with stones. Jaundice syndrome with cholestasis goes away on its own after the treatment of the disease itself. That is, when the stones pass into the intestinal region, yellowness disappears.
Malignant tumors in the pancreato-hepatobiliary zone are found in one 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 hypochondrium and epigastric regions, having a dull character and the ability to gradually increase.
- Darkening of the color of urine and discoloration of feces, as well as diarrhea.
- The skin color is yellowish, gradually turning into earthy. With obstructive jaundice, bilirubin is significantly increased.
- Itching on the skin.
- Nausea and vomiting.
- Abnormal weight loss.
- Lack of appetite.
- Elevated body temperature.
- Cholesterol deposits in the eyelids in the form of formations with clear edges.
- Liver enlargement.
Kind of pain
The pains when the ducts for bile are obstructed by calculi are spasmodic, sharp, give to the chest area, scapula and armpit on the right. A few days after a decrease in the intensity of hepatic colic, external symptoms of icteric syndrome appear. The liver area is painful on palpation. It is not possible to feel the gallbladder. If you click on the right hypochondrium, then breathing is involuntarily held.
Oncology
If a malignant neoplasm in the pancreas becomes the cause of obstructive jaundice, pain appears in the epigastric region and gives to the back. The gall bladder is distended and causes pain on palpation. The liver acquires a dense or elastic consistency, is increased in size, and also has a nodular structure. The spleen is not palpable. Jaundice syndrome is preceded by a lack of appetite and itching of the skin.
An increase in liver size is a common symptom in obstructive jaundice. This is due to overflow of the liver with bile, as well as the inflammatory process in the bile ducts.
Itching of the skin can occur long before all other symptoms of jaundice. Itching is not amenable to medical treatment, strong and debilitating. In places of combing, hematomas appear. Cancers and, as a result, jaundice are often accompanied by unmotivated weight loss.
Fever is caused by an 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 appears in the same way as many other diseases similar to it. Therefore, the correct diagnosis can be quite difficult.
For the diagnosis of obstructive jaundice at an early stage, laboratory methods are poorly suited. Elevated levels of bilirubin and cholesterol, as well as high alkali phosphatase activity, can indicate both intrahepatic type cholestasis and viral hepatitis.
In connection with the foregoing, instrumental methods play a decisive role in the diagnosis of obstructive jaundice (ICD code). The most commonly used methods are:
- Ultrasound study. This method allows you to detect the presence of calculi, 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 the tumor formation from the accumulation of calculi in the gallbladder.
- Duodenography relaxation type. In fact, this is an x-ray of the duodenum, however, the study is carried out in conditions of creating artificial organ hypotension. This method is used to detect metastases in the duodenum with pancreatic cancer.
- Endoscopic retrograde cholangiopancreatography. It is used in cases when an ultrasound scan is not enough, especially if a blockade of a large 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 you to accurately diagnose even small tumor formations, to take material from the duct for histology. This type of study is invasive, therefore its use is associated with a certain risk of complications.
- Percutaneous transhepatic cholangiography. This procedure is prescribed in case of blockade of the biliary tract to the liver. Before the start of the study, local anesthesia is performed, after which, under the control of ultrasound, 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, among them internal bleeding, peritonitis and leakage of bile.
- Radioisotope scan of the liver. 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. Used in cases where other methods have been ineffective and have not allowed to clarify the diagnosis. Laparoscopy is performed to detect meastasized cells, as well as to determine the extent of liver damage.
Treatment
Treatment of obstructive jaundice consists primarily in eliminating the root cause of the appearance of such symptoms. For this, a special diet is followed, and a conservative drug treatment is also carried out. It consists in the intravenous administration of a glucose solution, various B vitamins, as well as drugs such as:
- Essential. Stimulates the blood circulation in the liver.
- "Vikasol." Prevents bleeding.
- Trental. Contains glutamic acid.
- Antibiotic drugs.
In addition, plasmapheresis is used, which purifies the blood and enterosorption, aimed at releasing the body from toxins. Obstructive jaundice is also treated in surgery.
Surgical intervention
Depending on the nature of the disease, as well as in cases where conservative methods do not give a result, various types of surgical intervention are used, consisting in 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, since it is minimally invasive.
- Endoscopic cholecystectomy. It consists in the removal of the gallbladder through an endoscopic opening.
- Endoscopic papillosphincterotomy. It is carried out in order to remove stones that accumulate 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 were affected, for example, by a malignant neoplasm.
Food
With jaundice (ICD 10 K83.1), proper medical nutrition is very important. Before surgery, the diet is aimed at reducing the load on the liver 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 load 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. This can be stewed fruit, sweet teas, glucose solutions, etc. This will restore energy in the body and speed up metabolic processes. The prognosis for obstructive jaundice depends on the reason why it arose.
This question does not have a clear answer. If the patient does not receive qualified help on time, then the probability of a fatal outcome is not excluded. If you follow all stages of treatment, then there will be a quick recovery. The prognosis for oncology is unfavorable most often. Since there is a dangerous effect not only in the tumor, but also in its metastases that spread throughout the body. With timely therapy in the early stages of cancer, the disease can be stopped. And with modern methods of treating cancer patients, the patient's condition in the later stages is facilitated.
After the operation, the patient’s menu becomes more diverse, gradually cereals in milk, juices, vegetable soups, etc. are included in it. All food taken should be mashed and not hot. If 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 significantly limited, as are spices and spices. After the patient's condition is fully stabilized, he is allowed to eat stale bread and low-fat dairy products.