DR.JAMIL SAWAKED
DEFITION OF JAUNDICE
TYPES
A
PREHEPATIC
HAEMOLYSIS
HEPATIC
POSTHEPATIC
OBSTRUCTIVE OR SURGICAL
ANATOMY
ANATOMY
A
BILIRUBIN CYCLE
BROKEN DOWN RED CELLS ARE REMOVED BY R.E.S. HAEMOGLOBIN SPLITS INTO HAEM &GLOBIN GLOBIN & CELL WALL PROTEIN GO DOWN TO AMINOACIDS THEY ENTER THE AMINO ACID POOL
&
BILIRUBIN IS NOT REUSED [GOES TO THE LIVER] COMBINE WITH GLUCOURINC ACID TO FORM THE CONJUGATED [ DIRECT ] BILIRUBIN [ WATER SOLUBLE ]
Van den Bergh reaction [DIRECT] Alcohol added after van den Gergh [INDIRECT]
FERRITIN
TO BE REUSED
AMINOACIDS
AMINOACID POOL
WATER SOLUBLE
BLOOD
URINE
BILIRUBIN CYCLE
1-STONES 2-STRICTURES; [BENIGN] 3-CA. HEAD OF THE PANCREASE 4-CHOLANGIOCARCINOMA 5-PERIAMPULLARY TUMOUR 6-PRESSURE FROM OUTSIDE;L.N.,M.SYN. 7-CHOLEDOCHAL CYST 8-PARASITES; FILLING THE LUMEN
PARASITES
HYDATID
PAPILLOMATOSIS
CHOLANGIOCARCINOMA
IN THE WALL:STRICTURES
BENIGN STRICTURES
MALIGNANT STRICTURES
MIRRIZI`s syndrome
BENIGN STRICTURES
1-BILIARY ATRESIA 2-IATROGENIC BILIARY SURGERY GASTRECTOMY HEPATIC RESECTION LIVER TRANSPLANT 3-INFLAMMATORY;CHOLANGITIS , PANCREATITIS, SCLEROSING
CHOLANANGITIS.
BILIARY ATRESIA
NORMAL
BILIARY ATRESIA
CAUSES
ORIGIN
1-DEUDENAL MUCOSA OR 2-C.B.D. OR
3-PANCREATIC DUCT
CHOLANGICARCINOMA
CHOLANGIOCARCINOMA
LIVER METASTASIS
C.B.D.STRICTURE
SCLEROSING CHOLANGITIS
Associated with U.Colitis in 70% of cases May lead to malignancy
Unknown aetiology Symptoms of cholangitis Treatment;Antibiotics Or liver transplant
Rosary beads
SYMPTOMS
PAIN YELLOW DISCOLOURATION SKIN &M.M. DARK URINE [TEA COLOUR] CLAY COLOUR STOOL ITCHING FEVER IF CHOLANGITIS SUPERVENE LOSS OF APPETITE LOSS OF WEIGHT IN MALIGNACY
SIGNS
LOSS OF Wt. IN MALIGNANCY TOXIC IN CHOLANGITIS, [CHARCOT`S TRIAD,;PAIN, FEVER ,JAUNDICE] YELLOW DISCOLOURATION OF SKIN,M.M. TROISIER`S SIGN. VIRCHOW`S NODE TENDER R.U.Q.[IN CHOLANGITIS] COURVOISIER` LAW[IN CA.HEAD OF PAN.] ABDOMINL MASS ASCITES[IN MAIGNANCY]
NODE
OR
[TROISIER`S SIGN]
2,4,7,9,10.DEPEND ON IT
COURVOISIER` LAW
INVESTIGATIONS
C.B.C. DIFF., ESR. L.FT. *S.ALK.P.* PROTHROMBIN TIME S. AMYLASE K.F.T. ELECTRLYTES URINE ANALSIS * BILIRUBIN * STOOL ANALYSIS,;FAT,BLOOD.
INVESTIGATIONS
U.S.
STONE
PERIAMPULLARY TUMOUR
ERCP
SPHINCTEROTOMY
ERCP
C.B.D.STONE
STENT
STONE REMOVED
C.B.D. STRICTURE
CHOLANGICARCINOMA
CHOLANGIOCARCINOMA
M.R.C.P
P.T.C.
PEROPERATIVE CHOLANGIOGRAM
T.TUBE CHOLANGIOGRAM
DRAIN CHOLANGIOGRAM
MANAGEMENT-1
CORRECTION OF THE DERENGED PARAMETRES ADMINISTRATION OF VITAMIN K ANTIBIOTICS MANNITOL PRE, INTRA and POSTOPERATIVELY TO PREVENT HEPATO-RENAL SHUTDOWN
MANAGEMENT-2
1. STONE-SPHINCTEROTOMY 2.STONE-EXPLORATION OF C.B.D. 3.STRICTURE-RESECTION ANASTOMOSIS FOR SHORT STRICTURES 4.STRICTURE-STENT FOR SHORT AND LONG 5.CA.HEAD OF THE PANCREASE =EARLY-WHIPPLE`S OPERATION[PANCREATICO-DUODENECTOMY. =LATE-BYPASS SURGERY[CHOLECYSTOJUJENOSTOMY
WHIPPLE`S OPERATION
Pancreatico-duodenoctomy