How to distinguish from other jaundices
There are three types of jaundice. In case of hepatitis, for example with hepatitis, the liver cells themselves suffer, and weakness, nausea and high levels of ALT and AST come to the fore. With hemolytic, red blood cells are destroyed, the skin turns yellow, but urine and feces remain the usual color, and indirect bilirubin predominates in the blood. Mechanical is characterized by dark urine, light feces, itchy skin and a predominance of direct bilirubin along with high alkaline phosphatase and GGT. Ultimately, the level of the block is determined by ultrasound and tomography, and not by the appearance of the skin.
- Mechanical: dark urine, light feces, itching
- Hepatic: weakness, nausea, high ALT and AST
- Hemolytic: normal color urine and stool
- Key analysis - bilirubin fractions
- Dilated ducts on ultrasound indicate an obstruction
Reasons
The most common benign cause is a stone that has passed from the gallbladder into the common duct. Less common are cicatricial narrowings after operations and inflammation, compression of the duct by the enlarged head of the pancreas in chronic pancreatitis, parasitic diseases, and duct cysts. Among malignant causes, the leading place is occupied by cancer of the head of the pancreas, tumors of the bile ducts and major duodenal papilla, and metastases to the lymph nodes of the hilum of the liver. An important feature: tumor jaundice often develops gradually and painlessly, whereas with a stone it is usually preceded by an attack of pain.
- Common bile duct stone
- Scar narrowing of the ducts
- Chronic pancreatitis with duct compression
- Pancreatic head cancer
- Tumors of the bile ducts and papilla
- Parasitic diseases
- Bile duct cysts
Why is bile stagnation dangerous?
Bile is necessary for the digestion of fats and the absorption of fat-soluble vitamins, including vitamin K, which is involved in blood clotting. Therefore, with prolonged jaundice, coagulation is impaired and a tendency to bleeding appears. The accumulation of bile components damages liver cells, and over time, liver failure develops, and in case of complete blockage, biliary cirrhosis. Stagnation creates conditions for infection and the development of cholangitis. The kidneys also suffer. That is why, with obstructive jaundice, the outflow of bile is first restored, and only then radical treatment of the cause is carried out.
- Malabsorption of fats and vitamins
- Bleeding due to vitamin K deficiency
- Liver cell damage
- Risk of cholangitis and sepsis
- Kidney damage due to prolonged jaundice
- Development of biliary cirrhosis during chronic block
Survey
In blood biochemistry, total and direct bilirubin, alkaline phosphatase, GGT, ALT and AST, albumin and coagulation parameters are determined. Ultrasound is performed first: dilation of the intrahepatic ducts confirms the mechanical nature of jaundice and indicates the level of the block. Magnetic resonance cholangiography provides a detailed picture of the ducts without intervention. Computed tomography with contrast is needed if a tumor is suspected and to assess the extent of the process. Sometimes endoscopic ultrasound with the possibility of biopsy is used. Viral hepatitis must be excluded.
- Bilirubin fractions, alkaline phosphatase, GGT
- Coagulogram and albumin
- Ultrasound of the liver and bile ducts
- Magnetic resonance cholangiography
- Computed tomography with contrast
- Endoscopic ultrasound with biopsy
- Markers of viral hepatitis
Treatment
The primary task is to unload the bile ducts. In case of a stone, endoscopic intervention is performed: the mouth of the duct is dissected and the stone is removed, if necessary, crushed. In case of tumor narrowing, a stent is installed that restores outflow, and if endoscopic access is not possible, percutaneous drainage is performed under ultrasound and X-ray control. At the same time, blood clotting is corrected, solutions are administered, and antibiotics are prescribed for signs of infection. After bilirubin has decreased, the issue of radical treatment is decided: removal of the gallbladder for stones or surgery for a tumor.
- Endoscopic removal of stone from the duct
- Stenting for tumor narrowing
- Percutaneous drainage of the biliary tract
- Correction of coagulation and water balance
- Antibiotics for signs of cholangitis
- Radical surgery after reducing bilirubin
- Observation and replacement of the stent at the appointed time
