Jaundice mechanical

Jaundice is a pathological syndrome caused by a violation of the outflow of bile from the bile ducts. Causes of mechanical jaundice: malformations [atresia, choledocha cysts, duodenal diverticula, located near the large papilla of the duodenum (fater nipple), gallbladder hypoplasia]; Cholelithiasis, stones in the common bile and hepatic ducts, pitted stones of the large papilla of the duodenum, inflammatory strictures and stenoses (strictures of the bile ducts, inflammatory or scar papillostenosis); Inflammatory diseases (acute cholecystitis, pericholecystitis, cholangitis, pancreatitis, alveolar echinococcosis in the gates of the liver); Tumors (papillomatosis of the bile ducts, cancer of the hepatic and common bile ducts, large papilla of the duodenum, head of the pancreas, metastasis and lymphoma in the portal of the liver).

The blockage of the ducts leads to a disruption in the exchange of bile acids, which causes itching. In addition, with cholelithiasis often there is hypercholesterolemia and insufficient absorption of fat-soluble vitamins, especially vitamin K, and sometimes hypoproteinemia. Stagnation of bile, especially in combination with purulent cholangitis, leads to severe violations of the functional state of the liver, which causes the development of acute liver failure. Clinically, jaundice is detected with a serum bilirubin level above 1.5 mg% (26 mmol / l). The main question facing the surgeon: with what jaundice does he deal with - mechanical post-hepatic or pre- and intra-hepatic? All research methods are aimed at solving this problem. The next question is the cause of mechanical jaundice. In the solution of the first question, a biochemical blood test is used, in particular the determination of the level of bilirubin and the ratio of its fractions, the predominance of the direct fraction is characteristic of mechanical jaundice; Study of transaminases of blood serum and alkaline phosphatase (their increase is characteristic for parenchymal jaundice). Oral and intravenous cholecystocholangiography with mechanical jaundice should not be used, since under conditions of a sharp decrease in the alimination function of the liver, it can not give any information. The most informative are ultrasound, endoscopic retrograde pancreatocholangiography, percutaneous, transhepatic cholangiography. Additional information can be given by scanning the liver with radioactive gold or technetium, liver angiography. However, it should be remembered that, with mechanical jaundice, an excessive examination is fraught with loss of time and, naturally, more frequent development of hepatic renal failure.