Short course on Jaundice

You need first of all to optimize the coagulation system, by checking the prothrombin and partial thromboplastin times and also the platelet count. Vit K often will not be enough to normalize the former, and plasma may be needed. I would not do an elective operation with a platelet count below 50,000. If you really want to be prudent, a bleeding time can be checked. That is the gold standard, and should be less than 12 min.

Next you have to find out the cause of the jaundice. Of course, if the alkaline phosphatase enzyme is higher than the transaminases and the conjugated bilirubin is 80% of the total bilirubin, then the jaundice is likely to be obstructive. Most surgeons would want an ultrasound to check for dilated ducts, stones, pancreatic tumors, and liver metastases. Endoscopic or transhepatic cholangiography, computerized tomography, and technicium hepatobiliary scans can be useful in determining the site of the obstruction. Patients with non-obstructive jaundice should be viewed by the surgeon with a jaundiced eye; they are likely to do “not well”, even with optimum management. Their portal vein pressure may be elevated, leading to impressive bleeding even when their coagulation parameters have been “tuned up”.

Treatment of obstructive jaundice can be surgical tumor resection, stone removal, or bypass. Endoscopists can pull down stones with baskets and balloons, they can cut strictures at the ampulla of Vater, and they can pass stents to internally bypass obstructions due to strictures, tumors or impossible-to-remove stones.

And thats my short course on Jaundice!

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  1. Did'ko

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