Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary 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] Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth