Obstructive Jaundice

Abstract

A jaundiced patient usually presents with scleral icterus or yellow discoloration of the mucous membranes or skin. A history of pain, pre-vious biliary Operations, and ingestion of hepatotoxic drugs are impor-tant findings. The laboratory evaluation includes a total bilirubin level; a level higher than 10 mg/dl usually indicates a malignant process whereas a level less than 10 mg/dl may be found in patients with choledocholithiasis, a hemolytic process or hepatitis. Laboratory evaluation should also include fractionating the bilirubin as jaundice due to obstruction usually has a preferential rise in the direct or the conjugated bilirubin fraction. Serum transaminases should be checked to rule out hepatitis as usually the serum transaminases will be greater than 1,000 in acute hepatitis. The alkaline Phosphatase is very impor-tant as it is an indication of obstruction when elevated; an elevated level may indicate a segmental hepatic duct obstruction firom malig-nancy if the bilirubin is normal. A coagulation profile may reveal signs of hepatic parenchymal disease such as cirrhosis of the liver which can impair synthesis of coagulation proteins. If hepatitis and hemolytic processes have been ruled out, an ultrasound is the first diagnostic test obtained.