Skip to Main Content

+

  • • Classified as obstructive (conjugated bilirubinemia) or nonobstructive (unconjugated bilirubinemia)

    • Adult etiologies include:

    • -Obstruction due to benign or malignant causes (stones, tumors, strictures)

      -Sludge or stasis due to infection or total parenteral nutrition (TPN)

      -Hemolysis or hepatocellular dysfunction

    • Neonatal etiologies include:

    • -Physiologic

      -Biliary atresia

      -Choledochal cyst

      -TPN

      -Hemolysis

      -Alagille syndrome

      -Intrahepatic bile duct paucity

      -Byler syndrome

++

Symptoms and Signs

+

  • • Jaundice

    • Malaise

    • Anorexia

    • Fatigue

    • Pruritus

    • Encephalopathy

    • Kernicterus

++

Laboratory Findings

+

  • • Hyperbilirubinemia (conjugated or unconjugated)

    • Associated elevation of liver function tests if hepatocellular dysfunction

    • Anemia if associated sepsis, bleeding, or hemolysis

++

Imaging Findings

+

  • US: Shows biliary dilatation if obstruction present

    CT: Shows biliary obstruction present and accompanying mass

    • ERCP, magnetic resonance cholangiopancreatography (MRCP), or percutaneous transhepatic cholangiogram (PTC): Shows biliary obstruction if mass present and proximal and distal extent

+

  • • Conjugated hyperbilirubinemia in neonate

++

Rule Out

+

  • • Anatomical obstruction to bile flow

+

  • • History and physical exam

    • Bilirubin (conjugated and unconjugated)

    • US

    • CT

    • ERCP, MRCP, or PTC

++

When to Admit

+

  • • Cholangitis

    • Obstructive jaundice in neonate

    • Encephalopathy

++

Surgery

+

  • • Resolution of bilary tract stone disease by cholecystectomy and decompression of common bile duct by operative, radiologic or endoscopic intervention

    • Resection with biliary reconstruction of mass causing obstruction

    • Biliary-enteric bypass if benign stricture or unresectable malignant disease

++

Indications

+

  • • Biliary obstruction

++

Contraindications

+

  • • Medical comorbidity precluding resection or general anesthesia

    • Extrahepatic disease if malignant cause

++

Medications

+

  • • Ursodiol

    • Phototherapy (neonate)

    • Exchange transfusion (neonate)

++

Treatment Monitoring

+

  • • Serum bilirubin

++

Complications

+

  • • Biliary-enteric anastomotic leak or stricture

++

References

Cipolletta L. et al. Endoscopic palliation of malignant obstructive jaundice: an evidence-based review. Digestive & Liver Disease. 2007, 39(4):375-88.  [PubMed: 17317347]

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.