CLINICAL DIAGNOSTIC MANUAL
Obstructive jaundice occurs when there is a blockage in the bile ducts that prevents the normal flow of bile from the liver to the small intestine. This blockage can be partial or complete and may be located in the intrahepatic or extrahepatic bile ducts.
The accumulation of conjugated bilirubin in the blood due to this obstruction is what causes jaundice. It is crucial to identify and treat the underlying cause to prevent severe complications such as infections and chronic liver damage.
Pathology | Symptoms and Clinical Signs | Suspected Diagnosis | Confirmatory Diagnosis |
Gallstone disease | Right upper quadrant abdominal pain, jaundice, dark urine, pale stools, nausea, vomiting | History of biliary pain, abdominal ultrasound | ERCP, CT/MRI, ultrasound with cholangiography |
Pancreatic head cancer | Jaundice, weight loss, abdominal pain, anorexia, dark urine, pale stools | History of weight loss and anorexia, abdominal ultrasound | Abdominal CT/MRI, ERCP with biopsy, tumour markers (CA 19-9) |
Sclerosing cholangitis | Jaundice, pruritus, fatigue, abdominal pain, fever, chills | History of inflammatory bowel diseases, abdominal ultrasound | ERCP, CT/MRI, liver biopsy, autoimmune tests |
Primary biliary cirrhosis | Jaundice, pruritus, fatigue, hepatomegaly | History of autoimmune diseases, blood tests (elevated alkaline phosphatase, GGT) | Autoimmune tests (AMA), liver biopsy, abdominal ultrasound |
Drug-induced | Jaundice, dark urine, pale stools, pruritus, abdominal pain | History of hepatotoxic drug use, blood tests (elevated transaminases) | Medication history, improvement after drug cessation, liver biopsy if necessary |
Pregnancy (intrahepatic cholestasis) | Jaundice, pruritus (especially on palms and soles), dark urine, pale stools | History of pregnancy, blood tests (elevated bilirubin and bile salts) | Detailed medical history, improvement after delivery |
Alcoholic cirrhosis | Jaundice, fatigue, weight loss, hepatomegaly, ascites, dark urine, pale stools | History of excessive alcohol consumption, blood tests (elevated transaminases, GGT, alkaline phosphatase) | Liver biopsy, abdominal ultrasound, abdominal CT/MRI |
Dubin-Johnson syndrome | Mild jaundice, generally asymptomatic | Blood tests (elevated conjugated bilirubin), family history | Genetic testing, liver function tests |
Σχόλια