Obstructive Jaundice

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 obstruction 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 leads to jaundice. It is essential to identify and treat the underlying cause to prevent serious complications such as infections and chronic liver damage.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Biliary lithiasis (gallstones)	Right upper quadrant abdominal pain, jaundice, dark urine, pale stools, nausea, vomiting	Clinical 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	Clinical 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	Clinical history of inflammatory bowel disease, abdominal ultrasound	ERCP, CT/MRI, liver biopsy, autoimmune tests
Primary biliary cirrhosis	Jaundice, pruritus, fatigue, hepatomegaly	Clinical 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	Clinical history of pregnancy, blood tests (elevated bilirubin and bile salts)	Detailed clinical 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 analysis, liver function tests