Description of obstructive jaundice: causes, symptoms and features of treatment

What is obstructive jaundice? Causes of development and methods of treatment of this disease will be described below. Also you will learn about what symptoms are characteristic for this disease and how it is diagnosed.

Basics

For obstructive jaundice, there is an increased content of substances such as bilirubin in tissues. This element gives the skin, and also mucous membranes a yellowish color.

Bilirubin is called a bile pigment. According to experts, he has two factions: direct, that is, connected, and indirect, that is, free.

Thus, for obstructive jaundice is characterized by excessive accumulation of the element, which occurs as a result of complete or partial overlapping of the lumen of the bile ducts. Another name for this disease is mechanical jaundice.

The main causes of the disease

Differential diagnosis of causes of obstructive jaundice should be carried out only in a hospital. About what research methods are used, we will tell below.

In the normal state of the patient, bile, formed in the liver, must be removed to the duodenum at certain intervals in order to take a direct part in the digestion process. However, in some cases this does not happen. The following reasons may be an obstacle for such a process:

• stenosis, or so-called narrowing of the ducts, as well as mucosal edema in the presence of scar post-inflammatory strictures( eg, observed with cholangitis or cholecystitis) or tumor compression;
• mechanical obstruction, or the so-called overlapping of a portion of the bile ducts by displaced concretions( stones) in the presence of cholelithiasis.

All of the above pathological phenomena lead to stagnation of bile( i.e., the formation of cholestasis), resulting in hypoxia, which damages hepatocytes.

It should also be noted that the cause of obstructive jaundice can be abscess, gall bladder cyst or pancreas, as well as parasites such as ascarids or echinococcus.

Symptoms of the disease

How does obstructive jaundice appear? Symptoms of this disease can not be noticed quite difficult. As a rule, such a disease develops sharply.

According to experts, jaundice is manifested by such symptoms as:

• nausea, fever, vomiting;
• painful stitching pains in the right hypochondrium, which grow undulating and irradiate into the right scapula or collarbone;
• discoloration of the stool, since bilirubin no longer enters the intestine;
• release of bilirubin together with urine, which contributes to its dark-brown color;
• severe itching of the skin due to the accumulation of toxic bile acids in the body.

Other signs of the disease

How can one recognize the development of obstructive jaundice? The disturbance of the bile flow of a chronic character occurs exactly as described above. However, the severity of such symptoms may increase depending on the duration of cholestasis. In some cases, patients also experience steatorrhea( ie, undigested fat in the stool), hyperpigmentation of the skin, loss of body weight and xanthoma( ie, lipid deposition in the skin).

It should also be noted that timely differential diagnosis of obstructive jaundice can prevent the development of a disease such as cirrhosis. This disease is characterized by the formation of connective tissue fibrous nodes in the liver, which arise in response to necrosis of hepatocytes due to metabolic and oxygen starvation disorders.

With the development of jaundice in the human body, the metabolism of fat-soluble vitamins is changing. In addition, a lack of vitamin D leads to osteoporosis( that is, increased brittleness of the bones), which makes the patient feel discomfort in the spine( in the lumbar or thoracic area), and also suffers from spontaneous fractures.

It should also be said that mechanical jaundice often provokes the development of hemorrhagic syndrome, which includes nasal bleeding, the appearance of vascular "stars" and bruises on the skin. Such phenomena are a consequence of vitamin K deficiency.

With a lack of vitamin A in the body, the patient's ability to twilight vision is reduced. In addition, prolonged cholestasis significantly increases the likelihood of formation of bile calculi.

Against the backdrop of jaundice development, the risk of infection and the occurrence of bacterial cholangitis, or the so-called inflammation of the bile ducts, increases. This condition is usually manifested by fever and pain in the right upper corner of the abdomen.

Methods for diagnosing mechanical jaundice

Now you know that obturation jaundice is characterized by an elevated bilirubin content in the blood. However, a biochemical blood test with such a disease does not give a complete diagnostic picture. Therefore, many specialists carry out other laboratory tests, and also apply various instrumental methods.

So, for the diagnosis of obstructive jaundice it is necessary: ​​

• to make a general blood test;
• undergo endoscopic retrograde or magnetic resonance cholangiopancreatography;
• to undergo computed tomography and ultrasound of the abdominal cavity organs;
• to make a laparoscopy with a targeted biopsy.

The totality of the results of these studies allows doctors to conclude that there is or is not a mechanical jaundice.

Obstructive jaundice: treatment of

As a rule, all patients diagnosed with "obstructive jaundice" are immediately hospitalized in a surgical hospital. After the survey, specialists start to directly treat the disease. Usually, the therapy of this disease is conservative. It is aimed at eliminating jaundice and cholestasis, as well as stabilizing the patient's condition. The treatment is carried out by taking hormonal means and using endoscopic methods.

Also for the elimination of jaundice are often resorted to surgical stages.

Operative intervention is carried out with the purpose of decompression( that is, to reduce pressure) in the biliary tract, as well as for the resumption of bile flow, prevention of liver failure and cirrhosis. In this case, not only open operations are used, but also laparoscopic ones, which are performed under the supervision of ultrasound or CT.By the way, the second is given a special preference because of the low probability of complications and a small incision.

Other methods of treatment

In addition to surgical intervention, the complex treatment of mechanical jaundice includes such activities as:

• hepatoprotection( intake of B vitamins, Essentiale), metabolism improvement( by taking ascorbic acid and Pentoxyl)use of ursodeoxycholic acid;
• detoxification therapy for the purpose of diuresis stimulation, administration of glucose solution, saline solutions, sodium chloride, haemodesis;
• correction of microcirculation in the vessels of the liver;
• antibacterial treatment in case of attachment of the infectious process;
• hormone therapy, which is supplemented with funds for the prevention of gastrointestinal ulcers.

Outcome of surgical intervention

It should also be noted that surgery with severe jaundice can have an adverse outcome. Therefore, such treatment is prescribed only for vital indications.

If the patient's condition allows, then it is necessary to wait for the recession of the cholestasis syndrome, and then re-therapy.