What is obstructive jaundice? The reasons for the development and treatment methods of this disease will be described below. You will also learn about the symptoms that are characteristic of this disease and how it is diagnosed.
Basic information
Obstructive jaundice is characterized by an increased content in the tissues of such a substance as bilirubin. This element gives the skin, as well as the mucous membranes, a yellowish color.
Bilirubin is called bile pigment. According to experts, it has two fractions: direct, that is, connected, and indirect, that is, free.
Thus, obstructive jaundice is characterized by excessive accumulation of the aforementioned element, which occurs as a result of complete or partial closure of the lumen of the biliary tract. Another name for this disease is obstructive jaundice.
The main causes of the development of the disease
Differential diagnosis of the causes of obstructive jaundice should be carried out only in a hospital. About which research methods are used, we will tell below.
In the normal condition of the patient, bile formed in the liver should be excreted into the duodenum with a certain frequency in order to directly participate in the digestion process. However, in some cases this does not happen. The following reasons may be an obstacle to such a process:
- stenosis, or the so-called narrowing of the ducts, as well as swelling of the mucous membrane in the presence of cicatricial post-inflammatory strictures (for example, those observed with cholangitis or cholecystitis) or compression by the tumor;
- mechanical obstruction, or the so-called overlap of a certain section of the bile ducts with displaced calculi (stones) in the presence of gallstone disease.
All these pathological phenomena lead to stagnation of bile (that is, to the formation of cholestasis), resulting in hypoxia, which damages hepatocytes.
It should be noted that the cause of obstructive jaundice can be an abscess, a cyst of the gallbladder or pancreas, as well as parasites such as roundworms or echinococcus.
Symptoms of the disease
How does obstructive jaundice manifest? Symptoms of this disease are not difficult to notice. As a rule, such a disease develops acutely.
According to experts, jaundice is manifested by such signs as:
- nausea, fever, vomiting;
- painful stitching pains in the right hypochondrium, which grow in waves and radiate into the right scapula or collarbone;
- fecal discoloration, since bilirubin no longer enters the intestines;
- the allocation of bilirubin with urine, which contributes to its staining in a dark brown color;
- severe itching of the skin due to the accumulation of toxic bile acids in the body.
Other signs of the disease
How can obstructive jaundice be recognized? Violation of the current of bile of a chronic nature occurs in exactly the same way as described above. However, the severity of such symptoms may increase depending on the duration of cholestasis. Also, in some cases, patients have steatorrhea (that is, undigested fat in the stool), hyperpigmentation of the skin, loss of body weight and xanthomas (i.e. lipid deposition in the skin).
It should be noted that the timely differential diagnosis of obstructive jaundice helps prevent the development of a disease such as cirrhosis. This disease is characterized by the formation of connective tissue fibrous nodes in the liver, which occur in response to hepatocyte necrosis due to metabolic disorders and oxygen starvation.
With the development of jaundice in the human body, the metabolism of fat-soluble vitamins changes. In addition, a lack of vitamin D leads to osteoporosis (i.e., increased bone fragility), as a result of which the patient feels discomfort in the spine (in the lumbar or thoracic region), and also suffers from spontaneous fractures.
It should also be said that obstructive jaundice often provokes the development of hemorrhagic syndrome, which includes nosebleeds, the appearance of vascular "stars" and bruises on the skin. Such effects are a consequence of vitamin K deficiency.
With a lack of vitamin A in the body, the patient's ability to twilight vision decreases. In addition, prolonged cholestasis significantly increases the likelihood of bile stones.
Also, against the background of the development of jaundice, the risk of infection and the occurrence of bacterial cholangitis, or the so-called inflammation of the bile ducts, increases. This condition is usually manifested by fever and pain in the upper right corner of the abdomen.
Diagnostic methods for obstructive jaundice
Now you know that obstructive jaundice is characterized by an increased content of bilirubin in the blood. However, a biochemical blood test for such a disease does not give a complete diagnostic picture. Therefore, many experts conduct other laboratory tests, as well as apply various instrumental methods.
So, for the diagnosis of obstructive jaundice it is necessary:
- make a general blood test;
- undergo endoscopic retrograde or magnetic resonance cholangiopancreatography;
- undergo computed tomography and ultrasound of the abdominal organs;
- do a laparoscopy with a targeted biopsy.
The totality of the results of these studies allows doctors to conclude the presence or absence of obstructive jaundice.
Obstructive jaundice: treatment of the disease
As a rule, all patients diagnosed with obstructive jaundice are immediately hospitalized in a surgical hospital. After the examination, specialists begin the direct treatment of the disease. Usually, the treatment of this disease is conservative. It is aimed at eliminating jaundice and cholestasis, as well as stabilizing the patient's condition. In this case, treatment is carried out by taking hormonal drugs and using endoscopic methods.
Also, to eliminate jaundice, they often resort to surgical stages.
Surgery is carried out with the aim of decompression (that is, to reduce pressure) in the biliary tract, as well as to resume the flow of bile, prevent liver failure and cirrhosis. In this case, not only open operations are used, but also laparoscopic ones, which are performed under the supervision of ultrasound or CT. By the way, the second are particularly preferred because of the low probability of complications and a small incision.
Other treatments
In addition to surgery, an integrated treatment regimen for obstructive jaundice includes such measures as:
- hepatoprotection (taking B vitamins, Essentiale), improving metabolism (by taking ascorbic acid and Pentoxyl), the use of ursodeoxycholic acid;
- detoxification therapy to stimulate urine output, the introduction of glucose solution, saline solutions, sodium chloride, hemodesis;
- correction of microcirculation in the vessels of the liver;
- antibacterial treatment in case of attachment of an infectious process;
- hormone therapy, which is supplemented by means for the prevention of gastrointestinal ulcers.
Surgical outcome
It should also be noted that surgical intervention with severe jaundice can have an unfavorable outcome. Therefore, such treatment is prescribed only for health reasons.
If the patient’s condition allows, then it is necessary to wait for the recession of cholestasis syndrome, and then repeat the therapy.