Obstructive jaundice

Aetiology (bold most common)

• Benign
  • Choledocholithiasis
  • Benign stricture (see separate topic)
  • Inflammatory
    • Chronic pancreatitis
    • Pseudocyst
    • PSC
    • IgG4 cholangiopathy
    • Post-radiation therapy
  • Infectious
    • TB
    • Viral
    • Parasitic
    • HIV cholangiopathy
  • Other
    • Ischaemic (hepatic artery thrombosis)
    • Trauma
    • Vasculitis
    • Mirizzi's syndrome
    • Post-biliary sphincterotomy
• Malignant
  • Pancreatic
  • Cholangiocarcinoma
  • Ampullary cancer
  • Gastric cancer
  • Hepatoma
  • Metastatic disease

Pathophysiology

• With blocked bile excretion, conjugated bilirubin accumulates in blood, and is mainly excreted in urine, turning it dark amber
• By contrast, unconjugated bilirubin is not excreted in urine, so urine may not be as dark in pre-hepatic jaundice
• In obstructive jaundice, there is no stercobilin in stools, and hence the pale colour

Investigation

• To follow