Obstructive Jaundice

What is obstructive jaundice?

Obstructive jaundice is a condition in which there is blockage of the flow of bile out of the liver. This results in an overflow of bile and its by-products into the blood, and bile excretion from the body is incomplete. Bile contains many by-products, one of which is bilirubin, a pigment derived from dead red blood cells. Bilirubin is yellow, and this gives the characteristic yellow appearance of jaundice in the skin, eyes, and mucous membranes. Symptoms of obstructive jaundice include yellow eyes and skin, abdominal pain, and fever.

Digestive Problems Spotlight

Any type of obstruction that blocks the flow of bile from the liver can cause obstructive jaundice. Most commonly, gallstones create the blockage. Other causes of obstruction include inflammation, tumors, trauma, pancreatic cancer, narrowing of the bile ducts, and structural abnormalities present at birth.

The signs and symptoms of obstructive jaundice differ depending on the completeness of the blockage, and the disease course varies among individuals. Some people with obstructive jaundice may have no symptoms initially, but if the condition persists, they may have severe abdominal pain, fever, nausea, and vomiting. Complete blockage may also occur, posing a risk of infection leading to liver and gallbladder damage. Fortunately, in most cases, obstructive jaundice can be treated with intravenous fluids, antibiotics, and surgical removal of the obstruction.

Untreated, obstructive jaundice can lead to serious infection that spreads to other parts of the body. Seek immediate medical care for serious symptoms such as high fever (higher than 101 degrees Fahrenheit), severe abdominal pain, abdominal swelling, and nausea with or without vomiting.

Seek prompt medical care if you are being treated for obstructive jaundice but mild symptoms recur or are persistent.

Common symptoms of obstructive jaundice

Obstructive jaundice can cause any of the following symptoms, and at times, any of these symptoms can be severe:

  • Abdominal pain (typically occurs in the right upper quadrant of the body)
  • Dark-colored urine
  • Diarrhea
  • Easy bleeding or bruising
  • Fever and chills
  • Itchy skin
  • Loss of appetite (anorexia)
  • Malaise or lethargy
  • Pale stools
  • Unintentional weight loss
  • Yellow coloration of the eyes and skin (jaundice)

Serious symptoms that might indicate a life-threatening condition

In some cases, obstructive jaundice can be life threatening. Seek immediate medical care if you, or someone you are with, have any of these life-threatening symptoms including:

  • Abdominal swelling, distension and bloating
  • High fever (higher than 101 degrees Fahrenheit)
  • Nausea with or without vomiting
  • Severe abdominal pain

Causes of obstructive jaundice

Obstructive jaundice is caused by conditions that block the normal flow of bile from the liver into the intestines including:

  • Biliary stricture (narrowing of the bile duct)
  • Cancer of the gallbladder or pancreas
  • Cholangitis (infection or inflammation of the common bile duct)
  • Cholelithiasis (gallstones)
  • Congenital structural defects
  • Cysts of the bile duct
  • Lymph node enlargement
  • Pancreatitis
  • Parasitic infection
  • Trauma, including surgical complications

Diagnosis

As obstructive jaundice is a serious condition linked to high mortality rates early diagnosis is important. If it is caught early enough a curative operation to remove the blockage is possible, otherwise only palliative treatments that ease the symptoms and which may prolong life are available.

Obstructive jaundice can be diagnosed through various tests including blood tests to examine the level of bilirubin, as well as ultrasound of the liver and bile ducts to find out the exact cause of the obstruction is. CT scans are also used to help examine what is causing the blockage.

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive way to visualize the hepatobiliary tree MRCP provides a sensitive noninvasive method of detecting biliary and pancreatic duct stones, strictures, or dilatations within the biliary system. It is also sensitive for helping detect cancer. MRCP combined with conventional MR imaging of the abdomen can also provide information about surrounding structures (eg, pseudocysts, masses).

What are the risk factors for obstructive jaundice?

A number of factors increase your risk of developing obstructive jaundice. Not all people with risk factors will get obstructive jaundice. Risk factors for obstructive jaundice include:

  • Abdominal injury
  • Gallstones
  • Pancreatic cancer
  • Tumors in the area of the common bile duct

Treatment options for obstructive jaundice

Treatment options for obstructive jaundice depend on the exact cause of the jaundice and on the severity of the disease. Examples include:

  • Antibiotic therapy (if indicated for infection)
  • Endoscopic retrograde cholangiopancreatography (ERCP), an imaging procedure that allows treatment of some bile duct problems, including removal of gallstones that are causing obstruction
  • Intravenous fluids and pain medications
  • Nutritional support
  • Surgery or other procedures to repair anatomical defects or create alternative pathways for the flow of bile
  • Transplantation of the liver (if all other methods are unsuccessful and all of the liver is damaged)
  • Treatment for cancer, if present, which may include surgery, chemotherapy, or radiation therapy

What are the potential complications of obstructive jaundice?

You can help minimize your risk of serious complications by following the treatment plan that you and your health care professional design specifically for you. Complications of obstructive jaundice include:

  • Cirrhosis (scarring of the liver)
  • Coagulopathy (a blood clotting disorder)
  • Liver failure
  • Malabsorption syndrome (a disorder that interferes with the absorption of nutrients from food)
  • Spread of cancer
  • Spread of infection