tailieunhanh - Chapter 043. Jaundice (Part 9)

Choledocholithiasis is the most common cause of extrahepatic cholestasis. The clinical presentation can range from mild right upper quadrant discomfort with only minimal elevations of the enzyme tests to ascending cholangitis with jaundice, sepsis, and circulatory collapse. PSC may occur with clinically important strictures limited to the extrahepatic biliary tree. In cases where there is a dominant stricture, patients can be effectively managed with serial endoscopic dilatations. Chronic pancreatitis rarely causes strictures of the distal common bile duct, where it passes through the head of the pancreas. AIDS cholangiopathy is a condition, usually due to infection of the bile. | Chapter 043. Jaundice Part 9 Choledocholithiasis is the most common cause of extrahepatic cholestasis. The clinical presentation can range from mild right upper quadrant discomfort with only minimal elevations of the enzyme tests to ascending cholangitis with jaundice sepsis and circulatory collapse. PSC may occur with clinically important strictures limited to the extrahepatic biliary tree. In cases where there is a dominant stricture patients can be effectively managed with serial endoscopic dilatations. Chronic pancreatitis rarely causes strictures of the distal common bile duct where it passes through the head of the pancreas. AIDS cholangiopathy is a condition usually due to infection of the bile duct epithelium with CMV or cryptosporidia which has a cholangiographic appearance similar to that of PSC. These patients usually present with greatly elevated serum alkaline phosphatase levels mean 800 IU L but the bilirubin is often near normal. These patients do not typically present with jaundice. Summary The goal of this chapter is not to provide an encyclopedic review of all of the conditions that can cause jaundice. Rather it is intended to provide a framework that helps a physician to evaluate the patient with jaundice in a logical way Fig. 43-1 . Simply stated the initial step is to obtain appropriate blood tests to determine if the patient has an isolated elevation of serum bilirubin. If so is the bilirubin elevation due to an increased unconjugated or conjugated fraction If the hyperbilirubinemia is accompanied by other liver test abnormalities is the disorder hepatocellular or cholestatic If cholestatic is it intra- or extrahepatic All of these questions can be answered with a thoughtful history physical examination and interpretation of laboratory and radiologic tests and procedures. Further Readings Bosma PJ Inherited disorders of bilirubin metabolism. J Hepatol 38 107 2003 PMID 12480568 Ferenci P Wilson s disease. Clin Gastroenterol Hepatol 3 726 2005 .