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Gastrointestinal Surgery
Obstructive Jaundice
A faculty lecture on the approach to obstructive jaundice: how to tell the level of the block from the history and the bilirubin, which imaging answers which question, and how benign and malignant obstruction are managed. Delivered to undergraduate and postgraduate surgical trainees, and shared here as the original slide deck.
What this lecture covers
- Jaundice defined, and the difference from carotenaemia
- Anatomy of the biliary tree and the physiology of bilirubin
- Pathophysiology: where bilirubin rises and why
- Classification: pre-hepatic, hepatic and post-hepatic
- Differential diagnosis of unconjugated and conjugated hyperbilirubinaemia
- Benign and malignant causes, from gallstones to cholangiocarcinoma
- Clinical presentation and what the history tells you
- Investigations: ultrasound of gallbladder, ducts, liver and pancreas
- CT, ERCP, endoscopic ultrasound, FNAC, MRCP and PTC — what each adds
- Treatment: palliative drainage and definitive surgery
- Minimal access surgery and hepaticojejunostomy
- Therapeutic options for malignant strictures
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