Mechanical jaundice is a pathological condition characterized by a violation of the flow of bile through the bile ducts into the duodenum due to a mechanical obstruction. The synonyms of the disease include the terms: obstructive jaundice, aholic jaundice.
Obstruction of the biliary tract occurs as a negative consequence of a large group of pathologies of the pancreas and the human biliary system (the term refers to a system of bile ducts and sphincters that are focused on regulating the flow of bile). Common symptoms include yellowing of the skin, mucous membranes, sclera of the eyes, etc.
If you do not prescribe adequate treatment to help restore the full flow of bile, then the likelihood of complications is high - hepatic / renal failure, purulent form of cholangitis, sepsis, liver abscess. In extremely difficult cases against the background of the lack of medical assistance - the death of the patient.
Common causes of obstructive jaundice: cholelithiasis (predominantly under 30 years of age), malignant tumors, and pathologies of the digestive system organs. Ailment cannot be transmitted from person to person. Consider what symptoms accompany the disease and how to treat it.
Etiology of obstructive jaundice
In modern medicine, the pathology of the disease is well studied. Depending on the provoking factor, the pathological syndrome is classified into five large groups. The first group includes anomalies of an innate nature, as a result of which the biliary system could not develop to the end.
The second group includes benign transformations in the pancreas and the human biliary system, which are based on gallstone disease. For example, the formation of stones in the bile duct, protrusion of the duodenal wall, narrowing of the duodenal papilla, cysts, indurative pancreatitis, pancreatic necrosis, etc.
The third group is the stricture of the main bile ducts as a result of surgical intervention. The immediate cause includes accidental damage during surgical treatment or improper suturing.
Primary or secondary tumor tumors (fourth group). Implied pathology:
- Oncology of the gallbladder.
- Cancer of the head of the pancreas.
- The presence of metastasis in the liver due to tumors of different locations.
The fifth reason is parasitic diseases. For example, echinococcosis, due to which cysts are formed with parasitic contents. The lack of timely assistance is the probability of death over 90%.
The etiology of jaundice in newborns is based on a high level of bilirubin in the blood of a child. Bilirubin is a substance that is formed from hemoglobin and protein components containing iron. If the content of bilirubin increases, then the human skin becomes yellow. Genesis is as follows: adaptation to environmental conditions, immaturity of the enzyme system in a baby.
The most common cause of tumor tumors. The tumor can be localized in the liver, biliary tract, esophagus, the pancreas head.
Helminthiasis and congenital anomalies of the biliary system are relatively rare.
Clinical manifestations of obstructive jaundice
Mechanical jaundice in accordance with the International Classification of Diseases (ICD 10) is determined by code K83.1. The main clinical manifestations include discoloration of the skin, mucous membranes and eye sclera.
Patients often complain of dull pain in the epigastric region. Pain syndrome tends to increase. Stool liquid, frequent. Urine becomes dark in color, the smell is specific.
There is also itchy skin, occasionally the patient becomes sick, sometimes vomits. The patient loses his appetite, respectively, weight loss. Increases body temperature. Ultrasound shows an increase in the size of the liver.
When the stones blocked the bile ducts, the pain is always sharp, spasmodic. It can be given to the region of the sternum, or to the right axillary cavity, scapula. External symptoms are always detected 24-48 hours after the pain has subsided. On palpation of the projection of the liver, the person hurts Gall bladder palpation fails.
When the mechanism of development of jaundice is caused by a pancreatic tumor, a violation of the biliary system, biliary tract, the symptoms are:
- Painful sensations manifest themselves in the pit of the stomach, radiating to the back;
- On palpation, it is possible to reveal a distended gallbladder, pressure on it does not lead to painful sensations;
- The liver is enlarged in size, has a dense structure;
- If the formation of a malignant nature, then the structure contains the smallest nodules.
- Spleen rarely manage to probe.
An enlarged liver is the most common symptom of a long-term illness. It changes in size due to stagnation of bile and inflammatory processes in the bile ducts.
Itching skin worries patients even before the appearance of the clinic yellowness of the skin, more pronounced with tumor pathogenesis of pathology. It is quite strong and painful, gives a person a lot of anxiety. Medicines do not help to stop. On the skin, scratching occurs, the formation of small bruises is revealed. Weight reduction tends to develop during oncological processes.
If the patient's body temperature rises along with other symptoms, then infection of the biliary tract is suspected. A prolonged temperature increase is a differential symptom that distinguishes jaundice from hepatitis. Hepatitis is contagious, they can be infected by contact with a sick person at 3-4 weeks of the incubation period of the disease.
The gallbladder increases with tumors of the major duodenal papilla, pancreas head, and the terminal part of the choledochus.
The liver increases in 75% of the pictures, and the gallbladder in 65% of cases, which is found in 100% of patients with laparoscopic examination.
Diagnosis of jaundice
To make the correct diagnosis and prescribe an adequate conservative treatment, a comprehensive diagnosis is carried out. It includes a visual examination of the patient, palpation of the abdominal organs, laboratory and instrumental diagnostic methods.
If a patient has a neglected tumor, then a preliminary diagnosis is quite simple, because it is easily palpable. At an early stage of development of jaundice, diagnosis can cause certain difficulties, since symptoms can be a sign of many pathologies.
For example, with an increase in the concentration of "dangerous" cholesterol, bilirubin, alkaline phosphatase activity, both jaundice and viral hepatitis can be suspected.
To establish the correct diagnosis is a complete blood count. It allows you to identify a decline in red blood cells, hemoglobin. There is leukocytosis, high ESR - markers of the inflammatory process; also conduct biochemical analysis.
Instrumental diagnostic methods:
- Ultrasound procedure. Using the indirect method, it is possible to detect the expansion of the gall channel, the presence of stones in them, and focal liver damage. Additionally, ultrasound of the pancreas and other internal organs can be prescribed.
- Duodenography. This x-ray of the duodenum against the background of artificial hypotension, helps diagnose bowel deformity - Frostberg symptom.
- RCPGs are used in those clinical pictures, when the remaining instrumental examination options provided little information, and the blockade of the major duodenal papilla was suspected. A special tube is inserted into the duct through which the contrasting component enters, after which a series of shots are taken. Thanks to this method, it is possible to detect a tumor, to examine the contents of the channels. The method is informative, but since it is direct, it is often accompanied by various complications.
- Radioisotope scanning of the liver helps diagnose neoplasms and disorders caused by helminths.
Sometimes laparoscopy is used - an invasive technique that helps to identify metastases, to determine the degree of disruption of the liver during helminth infections - alveococcosis and echinococcosis.
Pathology therapy and prognosis
Therapy in most cases involves surgical intervention. Drug treatment consists of a rational diet. The patient is recommended to focus on the vegetable menu, consume fruits and dairy products.
Meals up to seven times a day in small portions. Cooking method - boiling. Be sure to follow the drinking mode - a few liters of fluid per day.
Glucose, vitamin B is administered intravenously. The administration of agents that protect the liver and increase blood circulation in the body is also carried out. To cure the patient, if necessary, prescribe antibacterial drugs. Before the surgery, blood coagulation tests are performed.
Surgical treatment of obstructive jaundice:
- If the biliary system is blocked, the bile ducts need to be drained in order to restore full bile flow.
- Mechanical excision of the gallbladder.
- Removal of stones in the gallbladder.
- Partial excision of the structure of the liver, which is affected by an abnormal process.
The main objective of the operation is to restore the normal flow of bile. If the case is complicated, then several surgical techniques can be combined at the same time.
The duration of obstructive jaundice varies over a wide range: from a couple of days with short-term blockage of calculi to a couple of months for tumors. Therefore, the prognosis of life and patient survival depends on the course of the underlying disease.
About jaundice described in the video in this article.