Obstructive jaundice
Introduction
Introduction When the biliary system is blocked, the excretion of bile is blocked, and the jaundice caused by the return of bilirubin to the blood is called obstructive jaundice. The obstruction site may be in the liver or outside the liver, with complete obstruction and incomplete obstruction. Common causes include capillary bile duct hepatitis, cholelithiasis, liver cancer, cholangiocarcinoma, pancreatic cancer, and biliary ascariasis.
Cause
Cause
For any reason, obstructive jaundice can occur as long as the bile duct is blocked.
First, it is a benign cause, the most common are:
(1) bile duct stones or gallril stones (Mirrizzi' syndrome) stones block the bile duct, causing bile to be discharged into the duodenum;
(2) Patients with chronic pancreatitis form pseudotumor of the head of the pancreas and compress the bile duct from the outside;
(3) The narrowing of the bile duct due to inflammation or surgery.
(4) Others such as rare biliary bleeding, blood clots block the bile duct, causing jaundice; liver flukes or worms mistakenly entering the biliary tract.
Second, it is a malignant cause
(1) a malignant tumor of the bile duct itself or the gallbladder (cholangiocarcinoma);
(2) pancreatic head cancer;
(3) Walter ampullary cancer - duodenal papillary carcinoma;
(4) The liver cancer embolism plugs the bile duct - the so-called jaundice type liver cancer;
(5) The enlarged lymph nodes of the bile duct in cancer patients cause bile duct obstruction.
Examine
an examination
Related inspection
Indirect bilirubin erythrocyte serum total bilirubin serum -glutamyltranspeptidase serum -glutamyltranspeptidase (-GTP) cholangiography
Laboratory inspection
Biochemical and immunological cancer markers, such as carcinoembryonic antigen (CEA), CA19-9, ferritin, 1 antitrypsin, etc., contribute to the etiological diagnosis of cancerous obstruction, but are not specific. Blood: serum transaminase is generally not significantly increased, with mild or moderate elevation in secondary hepatocyte damage; serum bilirubin is significantly increased, up to 510/mol/L in complete biliary obstruction ( 30mg/dl) or more, wherein the combined bilirubin accounts for more than 35% (up to about 60%). Calculous jaundice is often fluctuating; cancerous jaundice is often progressively deepened, but those caused by ampullary cancer can cause a brief reduction in jaundice due to cancerous ulcers. Serum alkaline phosphatase (ALP), gamma glutamyltransferase (GT), cholesterol (bile acid and lipoprotein-X (LP-X), etc. were significantly increased. Urine: dark urine, urinary bilirubin positive The urinary biliary tract is reduced. When the biliary tract is completely blocked, the urinary biliary tract can disappear.
Image inspection
X-ray plain film, gallbladder and biliary angiography, abdominal ultrasonography and abdominal CT, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are all helpful in the characterization of obstructive jaundice. And positioning diagnostics.
Diagnosis
Differential diagnosis
Generally, the true jaundice refers to the yellow stain of the skin, sclera and mucous membrane due to bilirubin deposition, and the serum bilirubin content is above 4umol/L. This yellow stain should be distinguished from some pseudo jaundice:
1 taking a large dose of a pingping treatment of tsutsugamushi, etc., yellow staining involving the skin exposed to the body, this yellow staining is a centripetal distribution, the closer to the cornea, the deeper the yellow stain, but the serum bilirubin does not increase;
2 Eat too much carrots, pumpkin, spinach, oranges, papaya, etc., because they contain a lot of carotene (yellow), especially when the hypothyroidism or liver dysfunction, the absorbed carotene is converted into vitamin A in the liver. The process is dysfunctional, causing carrots to be stored and causing carcinogenesis and yellowing of the skin. Yellow stains involve the forehead, nose and other parts of the palm, sole and sebaceous glands.
3 The elderly often have a subconjunctival fat accumulation in the internal iliac crest and yellow staining. Careful observation shows that the conjunctiva is uneven, serum bilirubin is not high, and the skin is not yellow. Therefore, the identification of the two contributes to the diagnosis of the disease.
