Approaching a patient with obstructive jaundice involves a systematic evaluation to identify the underlying cause and determine appropriate management.
Get the full solved assignment PDF of MME-105/As-1 of 2024 session now.
Here’s a step-by-step approach:
- **History Taking**: Obtain a detailed medical history, including the onset and duration of symptoms, presence of jaundice, abdominal pain, pruritus, dark urine, pale stools, weight loss, fever, nausea, vomiting, and any previous episodes of jaundice or biliary colic. Inquire about past medical history, including liver disease, biliary tract disorders, pancreatitis, gallstones, or previous abdominal surgeries.
- **Physical Examination**: Perform a comprehensive physical examination, focusing on signs of jaundice, abdominal tenderness, hepatomegaly, splenomegaly, signs of chronic liver disease (e.g., spider nevi, palmar erythema), and any other relevant findings.
3. **Laboratory Investigations**:
– **Liver Function Tests (LFTs)**: Measure serum bilirubin levels (total and direct), as well as liver enzymes (ALT, AST, ALP, GGT).
– **Complete Blood Count (CBC)**: Evaluate for anemia, leukocytosis, or thrombocytopenia.
– **Coagulation Profile**: Assess for abnormalities in clotting factors.
– **Serum Electrolytes and Renal Function**: Screen for electrolyte abnormalities and renal impairment.
4. **Imaging Studies**:
– **Ultrasonography**: Perform abdominal ultrasound as the initial imaging modality to evaluate for biliary tract obstruction, gallstones, dilated bile ducts, pancreatic abnormalities, or liver pathology.
– **CT/MRI**: Consider cross-sectional imaging (CT or MRI) if ultrasound findings are inconclusive or if further characterization of the biliary and pancreatic anatomy is needed.
- **Endoscopic Retrograde Cholangiopancreatography (ERCP) or Magnetic Resonance Cholangiopancreatography (MRCP)**: These procedures may be performed to visualize the biliary tree, identify the site and cause of obstruction, and obtain tissue samples if indicated.
- **Biopsy**: If malignancy is suspected, consider obtaining tissue samples for histological examination via percutaneous or endoscopic biopsy.
7. **Treatment and Management**:
– **Symptomatic Relief**: Provide symptomatic relief for pruritus, nausea, and pain.
– **Biliary Decompression**: Perform endoscopic or percutaneous biliary drainage to relieve obstruction and alleviate symptoms.
– **Treatment of Underlying Cause**: Treat the underlying cause of obstructive jaundice, which may include surgical intervention for gallstones or tumors, antibiotics for cholangitis, or chemotherapy/radiation therapy for malignancies.
- **Follow-Up**: Monitor the patient closely for response to treatment, resolution of symptoms, and complications such as cholangitis or hepatic decompensation. Arrange for appropriate follow-up visits and further investigations as needed.
A multidisciplinary approach involving gastroenterologists, hepatologists, radiologists, and surgeons is often necessary for the comprehensive management of patients with obstructive jaundice. Prompt diagnosis and intervention are essential to prevent complications and improve outcomes in these patients.