Pdf patients knowledge and perception of anaesthesia and the anaesthetist at a tertiary health care facility in ghana robert djagbletey, george aryee, raymond essuman, vincent ganu. Clinical pointers obstructive jaundice intrahepatic causes familial hereditary disorders dublin johnson syndrome, rotor syndrome, cholestatic jaundice of pregnancy, recurrent intrahepatic cholestasis acquired cholestatic drugs, viral and alcoholic hepatitis, tpn induced, biliary cirrhosis, sclerosing cholangitis. Neerja bharti 2 one of the objectives of modern anaesthesia is to ensure adequate depth of anaesthesia to prevent awareness. Specific problems may result from obstructive jaundice complicating pancreatic disease, and this is reflected in a higher mortality when surgery is performed in the presence of jaundice. The susceptibility to sepsis seen in obstructive jaundice is generally ascribed to a combination of gut failure with increased bacterial translocation and decreased kuppfer cell activity. However, its not the only one, as some genetic conditions can predispose one to copd. Perioperative management of obstructive jaundice pdf document. It is caused by elevated serum bilirubin levels in the unconjugated or conjugated form. Malignant biliary tract obstruction is a common clinical entity. Obstructive jaundice is the type of jaundice resulting from obstruction of bile flow to the duodenum from the biliary tract. Oct 16, 2019 zhu y, wang s, zhao s, qi l, li z, bai y. Caused by increased destruction of red blood cells, results in the inability to.
Most patients with obstructive jaundice caused by primary pancreaticobiliary malignancies and metastatic disease cannot be cured by surgical resection when diagnosed. Obstructive jaundice and perioperative management sciencedirect. Hardikar 1 approach to a case of obstructive jaundice dr. It provides objective standardized measurements for assessing the presence and severity of respiratory dysfunction. It can, but not always, be associated with icterus. Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resourcelimited countries. Complications of obstructive jaundice new doctor insights. There is no defined safe level of bilirubin, therefore early detection and treatment of neonatal hyperbilirubinemia is. Investigation and management of obstructive jaundice. Pdf obstructive sleep apnoea in pregnancy and its association with preeclampsia nc lintott, dg van zyl, jl burke 1216 doi. Routine preoperative laboratory and diagnostic screening. Figure 1 and figure 2 were sonograms had been taken from the study results showing dilatation of intrahepatic ducts and gall stones respectively. Oct 16, 2019 biliary obstruction associated with pancreatitis is observed most commonly in patients with dilated pancreatic ducts due to either inflammation with fibrosis of the pancreas or a pseudocyst. Summary jaundice is a clinical sign describing yellow pigmentation of the skin, sclera, and mucous membranes due to raised plasma bilirubin.
Sep 08, 20 clinical pointers obstructive jaundice intrahepatic causes familial hereditary disorders dublin johnson syndrome, rotor syndrome, cholestatic jaundice of pregnancy, recurrent intrahepatic cholestasis acquired cholestatic drugs, viral and alcoholic hepatitis, tpn induced, biliary cirrhosis, sclerosing cholangitis. Anesthesia management in obstructive jaundice patients for. Jaundice causes your skin and the whites of your eyes to turn yellow. The jca should be a participant in continuing education of clinicians, forecast important issues and trends in anesthesia, and foster responsible debate on controversial issues. Jaundice can cause hepatic and renal failure and can also lead to dysfunction of the coagulation cascade. Extrahepatic obstructive jaundice is an indication for surgical treatment, except perhaps in cases of sclerosing cholangitis.
It provides a guide to the perioperative assessment and anesthetic management of patients with widely prevalent comorbidities. The effect of obstructive jaundice on the distribution and elimination of propofol was studied in 15 patients with obstructive jaundice total serum bilirubin, tbl 17. Serum tumor markers are not sensitive or specific for malignancy in patients with obstructive jaundice. Ultrasound is the first imaging modality used in the algorithm for the investigation of cholestatic jaundice further imaging depends on whether the bile ducts are dilated if the bile ducts are dilated and an ultrasound fails to demonstrate a cause, further imaging depends on a provisional clinical diagnosis. Ptc was then carried out to differentiate the surgical from the medical jaundice, to identify the site of obstruction, and if possible, its nature. Discusses the anesthetic management of patients with jaundice. Obstructive jaundice is a common surgical problem that occurs when there is an obstruction to the passage of conjugated bilirubin from liver cells to intestine. Monitoring and managing hepatic disease in anaesthesia bja.
This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality. Routine abdominal ultrasonography shows the size of the bile ducts, which may define the. Full text get a printable copy pdf file of the complete article 5. Purpose of preanesthetic medication in jaundice and biliary tract surgery. Therefore, treatment of obstructive jaundice is one of the major aims of palliative therapy for carcinomas of the pancreatic head. The procedure was performed under local anaesthesia. This was a descriptive prospective study which was conducted at bugando medical.
Hospital mumbai 400012 2 management of obstructive jaundice 3 is there a jaundice. The current standard of care in the periprocedural. As red blood cells break down, your body builds new cells to replace them. Get a printable copy pdf file of the complete article 882k, or click on a page image below to browse page by page. In most patients with jaundice the clinical findings and laboratory tests provide enough information to allow one to distinguish between biliary obstruction and hepatobiliary disease 1, 2. Risk factors hemolytic jaundice transfusion reaction hemolytic anemia severe burns autoimmune hemolytic anemia hepatocellualr jaundice hepatitis yellow fever alcoholism obstructive jaundice extrahepatic obstruction may be. J obstructive jaundice whipples operationobstructive jaundice whipples operation anesthetic managementanesthetic management munisha agarwalmunisha agarwal professorprofessor deptt. An approach to obstructive jaundice krige continuing. Use of cortisone to prevent the development of uncontrollable hypotension. Haemostasis impairment in patients with obstructive jaundice. Obstructive jaundice and perioperative managements free download as pdf file. Anaesthetic management in obstructive jaundice slideshare. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
British journal of surgery 1997, 84, 147149 perioperative management of obstructive jaundice surgical procedures in patients with obstructive. This was recognised by whipple in 1935 who recommended an initial cholecystogastrostomy to relieve jaundice prior to a pancreatic resection. Unconjugated bilirubin is transported to the liver to be conjugated and. In newborn patients, biliary atresia must be suspected. Percutaneous transhepatic cholangiography its place in. Routine preoperative laboratory and diagnostic screening by thelma z. Obstructive jaundice and anesthesia linkedin slideshare. As patients with obstructive jaundice have high morbidity and mortality, early diagnosis of. For more than 20 years, percutaneous transhepatic biliary drainage procedures have allowed a nonsurgical approach to the management of malignant biliary obstruction. It is among the most challenging conditions managed by general surgeons and contributes significantly to high morbidity and mortality.
Biliary drainage in the management of obstructive jaundice therefore represents one of the most important issues in the palliative treatment of these patients. Full text full text is available as a scanned copy of the original print version. If you continue browsing the site, you agree to the use of cookies on this website. Bilirubin is a yellow chemical in hemoglobin, the substance that carries oxygen in your red blood cells. May 10, 2014 j obstructive jaundice whipples operationobstructive jaundice whipples operation anesthetic managementanesthetic management munisha agarwalmunisha agarwal professorprofessor deptt. Causes of postoperative jaundice can be divided into several functional categories including. Obstructive jaundice is often referred to as surgical jaundice because operating will relieve the obstruction and permit the free flow of bile 3. Ultrasound examination plays a great role in demonstrating the etiology of obstructive jaundice. Mr jones has presented today after his wife started to notice that his eyes were yellow. Courvoisier sign, described as a palpable gallbladder in the presence of painless jaundice, occurs in less than 25% of patients. Investigation and management of obstructive jaundice c d briggs m peterson abstract obstructive jaundice is a medical emergency. It is classified as hemolytic, hepatocellular, or obstructive.
Perioperative management and anaesthetic considerations for. Anesthesia and coexisting disease provides a timely, rapid overview of common and uncommon comorbidities that are encountered in the daytoday practice of anesthesiology. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Jaundice caused by obstruction of the drainage through the bile ducts, as may occur with gallstones. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. Pdf on may 28, 2018, yue long and others published anesthesia for patients with obstructive jaundice find, read and cite all the research. Malignant neoplasms should be suspected in older patients 50 years old presenting with painless jaundice. Original article from the new england journal of medicine surgical aspects of obstructive jaundice. The presentation of jaundice is a classic test of understanding of hepatic physiology and history is vital in working out the cause. Gheonea, adrian saftoiu, tudorel ciurea 1st medical clinic gastroenterology department, university of medicine and pharmacy craiova all illustrations belong to the collection of the medical i clinic. One hundred and five patients of surgical obstructive jaundice were admitted to army hospital, delhi from july 1991 to june 1994.
Smoking or secondary tobacco exposure is the most frequent cause of chronic obstructive pulmonary disease. Pathophysiology of obstructive jaundice springerlink. Jo jh, cho cm, jun jh, et al, for the eus study group of the korean society of gastrointestinal endoscopy. Obstructive jaundice has been hypothesized to impair hemostasis, immune function, and wound healing. Obstructive jaundice and perioperative management request pdf. The male to female ratio for benign jaundice was 1. Even when the diagnosis is certain, tests are indicated to define the site, the extent, and the nature of the obstruction so that the surgeon can plan the operation. Extrahepatic obstruction may be caused by bileduct plugging from gallstones, an inflammatory process, tumor or pressure from an enlarged gland intrahepatic obstruction may result from pressure on channels from inflamed liver tissue or exudates pathophysiology hemolytic jaundice.
Symptoms of obstructive jaundice can significantly impair qualityoflife unless intervention to decompress the biliary tract, either curative or palliative, is. Obstructive jaundice due to a blood clot after ercp. Management of obsructive jaundice by mohd taofiq authorstream. If there is a strong suspicion of common bile duct stones and initial imaging investigations are negative or equivocal, then ercp is indicated 12 preferred in patients who are poor surgical candidates or in whom sclerosing cholangitis. Notably, intravenous feedings predispose patients to bile stasis and a clinical picture of obstructive jaundice. Definition jaundice is a symptom or syndrome characterized by increased bilirubin concentration in blood. Palliative treatment of obstructive jaundice in patients. Management of patients with malignant obstructive jaundice. Obstructive jaundice does not affect the pharmacokinetics of propofol administered by a single intravenous bolus. Management of obsructive jaundice by mohd taofiq authorstream presentation. Obstructive jaundice and perioperative managements anesthesia. Postoperative jaundice, the presence of bilirubin elevation with or without clinical icterus appearing in the period following surgery, occurs as a result of numerous causes.
As a reminder, jaundice, or icterus refers to the yellowish discoloration of the skin, sclerae, and mucous membranes caused by retention of bilirubin and. Pdf anesthesia for patients with obstructive jaundice. Patients with tumors causing biliary tract obstruction are often asymptomatic until disease is significantly advanced. Go see your family physician for pulmonary function testing to confirm the diagnosis and then start treatment wregular follow up pft to demonstrate. The current standard of care in the periprocedural management. Etiological spectrum and treatment outcome of obstructive. Guide for authors journal of perianesthesia nursing. The causes of obstruction were choledocholithiasis 24 patients, periampullary carcinoma and carcinoma head of pancreas 32 patients, carcinoma gall. Public health cardiac surgery general anaesthesia vascular surgery muscle relaxant. Anaesthesia in patients with obstructive jaundice springerlink.
The increased incidence of obstructive jaundice amongst the females is due to the fact that gall stones are frequently found in them. The role of imaging methods in identifying the causes of. Frequency distribution of symptoms of obstructive jaundice among the study population. Postoperative jaundice is defined as the elevation of bilirubin that occurs after the completion of surgery and has many possible causes, associated laboratory findings, and implications. Also called mechanical, cholestatic jaundice or surgical jaundice. A free powerpoint ppt presentation displayed as a flash slide show on id. Jaundice can be caused by a wide variety of disorders which range from benign to lifethreatening conditions, such as gilberts syndrome and pancreatic cancer respectively. Jaundice is one of the most common causes of health problems, observed in 60% of term and 80% of preterm infants in the first week of life 1.
Patients were investigated as per the diagnostic protocol. The first task of the clinician caring for the jaundiced patient is to determine if jaundice is. The chiba fine needle was used, the conray 280 was employed as the contrast. Below, we give a structure to use to try to ascertain the causes. A case of obstructive jaundice and administration of anesthesia in such a case slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Biliary obstruction associated with pancreatitis is observed most commonly in patients with dilated pancreatic ducts due to either inflammation with fibrosis of the pancreas or a pseudocyst. Unlimited access to the largest elibrary of professional videos, images, documents, courses. A scenario could involve a presenting complaint of. For more than 20 years, percutaneous transhepatic biliary.
The jca should be a participant in continuing education of clinicians, forecast important issues and trends in anesthesia, and foster responsible debate on. The role of imaging methods in identifying the causes of extrahepatic cholestasis ion rogoveanu, dan ionu. Pdf on may 28, 2018, yue long and others published anesthesia for patients with obstructive jaundice find, read and cite all the research you need on researchgate. The disease, which represents congenital fibrosis of the extrahepatic biliary system, is divided into. Palliative treatment of obstructive jaundice in patients with. These keywords were added by machine and not by the authors. Congenital biliary atresia manifests in the early neonatal period as jaundice. The most common cause of obstructive jaundice is choledocholithiasis.
522 112 1040 1623 387 1501 777 1510 1413 1075 526 417 280 318 1103 649 1156 1647 1688 1143 927 463 1394 362 693 1085 832 1363 84 742 40 1091 496 1240 484 922 354 1266 678