Surgical Jaundice
Definition
Surgical jaundice refers to the clinical condition characterized by the obstruction of the bile duct, leading to the accumulation of bilirubin in the blood and tissues, resulting in jaundice.
Causes
- Obstruction of the bile duct
- Cholestasis
- Tumors or stones in the bile duct
- Inflammation or infection of the bile duct
- Trauma to the bile duct
- Congenital anomalies of the bile duct
Pathophysiology
- Obstruction of the bile duct leads to the accumulation of bile in the liver and bile ducts, resulting in cholestasis.
- Cholestasis leads to the accumulation of bilirubin in the blood and tissues, resulting in jaundice.
- Inflammation or infection of the bile duct can cause cholangitis, a serious infection of the bile duct.
Clinical Features
- Jaundice: a yellowing of the skin and eyes due to the accumulation of bilirubin.
- Pruritus: itching of the skin due to the accumulation of bile salts.
- Abdominal pain: pain in the upper right quadrant of the abdomen due to the obstruction of the bile duct.
- Fever: high temperature due to cholangitis.
Courvoisier’s Law
Courvoisier’s Law states that if a patient has a palpable gallbladder (Courvoisier’s sign), the obstruction of the bile duct is more likely to be due to a malignant tumor rather than a benign cause.
Diagnostic Workup
- Laboratory tests: liver function tests (LFTs), bilirubin levels, and bile acid levels.
- Imaging studies: ultrasound, magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) scans.
- Endoscopic retrograde cholangiopancreatography (ERCP): a minimally invasive procedure to visualize the bile ducts and remove any blockages.
Complications of Untreated Surgical Jaundice
- Cholangitis: a serious infection of the bile duct that can lead to sepsis and death.
- Biliary cirrhosis: scarring of the liver due to chronic cholestasis.
- Gallstone pancreatitis: pancreatitis due to the obstruction of the bile duct by a gallstone.
- Malignant obstruction: a malignant tumor that obstructs the bile duct, leading to jaundice and other complications.
Management and Treatment
- Surgical removal of the obstruction: cholecystectomy or bile duct resection.
- Endoscopic removal of the obstruction: ERCP or balloon dilation.
- Medical management: antibiotics for cholangitis, and supportive care for jaundice and pruritus.
Homoeopathic Therapeutic Medicines
- Chelidonium majus: for jaundice and pruritus.
- Taraxacum officinale: for cholestasis and liver dysfunction.
- Hydrastis canadensis: for liver and gallbladder dysfunction.
- Arsenicum album: for cholangitis and sepsis.
Important Points
- Jaundice is a clinical symptom that can be caused by a variety of conditions, including surgical jaundice.
- Cholestasis is a key pathophysiological mechanism in surgical jaundice.
- Courvoisier’s Law is a useful clinical tool for differentiating malignant from benign causes of bile duct obstruction.
- ERCP is a minimally invasive procedure that can be used to diagnose and treat surgical jaundice.
- Untreated surgical jaundice can lead to serious complications, including cholangitis and biliary cirrhosis.