<http://www.cancernorth.nhs.uk/livingwithcancer/Symptomsandsideeffects/Obstructiv
eJaundice>

Obstructive Jaundice and its treatment

Obstructive jaundice is one type of jaundice.
IIt can be caused by a variety of conditions.

What causes it?

It is caused by a blocked bile duct. This leads to the build-up of a
natural, body waste-product called bilirubin. Bilirubin is made as part of
the body’s way of getting rid of dead blood cells. Normally, it is
disposed of by the liver, becoming part of the green bile liquid that the
liver produces. From the liver, the bile is drained away through the
common bile duct, which connects the liver to the small intestine.

However, with obstructive jaundice, a blockage in the bile duct means that
the bilirubin cannot be removed, and stays in your blood stream. The level
of bilirubin in your blood and tissues rises. It is carried to your skin
and eyes, and tints them yellow.

[diagram there of upper gut - liver, common bile duct, pancreas,
gallbladder, duodenum/start of small intestine, hepatic vein, hepatic
artery]

What is obstructive jaundice?

Obstructive jaundice is yellowing of the skin or whites of the eyes. The
condition turns your urine dark, and makes your stools pale. You may also
experience:

   * Sleepiness
   * Extreme tiredness
   * Sickness
   * Itchy, dry skin

Your doctor will want to investigate the cause of the blockage. To do
this, an ultrasound scan or CT scan will be arranged, to get a picture of
the blood flow to and from your liver.

The causes of obstructive jaundice range from less serious conditions like
gallstones, through to more worrying conditions like pancreatic cancer.
This will need to be established so that your doctor can choose the
correct treatment for it, and treat the underlying condition.

How is it treated?
There are three ways of relieving the blockage that is causing the
jaundice. The first two procedures listed below are temporary measures.
They will help clear the jaundice while its cause is being established.
The third procedure, resection, is only suitable once the cause has been
found, and its use depends on what the cause is.

   * ERCP (Endoscopic Retrograde Cholangio Pancreatography)
     In this procedure, a type of instrument for looking inside the body,
called an endoscope, is used. It is a thin, telescopic tube, with a light
and a small camera on the end of it. It is passed through your mouth,
through your stomach, and into the first part of your small intestine.
During the procedure, a small tube, like a straw (called a stent), is
placed into the blocked bile duct to make a passage-way. The stent allows
the bile from your liver to flow freely into your small intestine again,
and so relieve the jaundice.

     Beforehand, you will be given some sedation to ensure that you feel
no pain.

     The procedure may be complicated by bleeding, damage to the bowel,
infection or pancreatitis (inflammation of the pancreas). One in a hundred
patients experience serious complications.

   * PTC (Percutaneous Transhepatic Cholangiography) and percutaneous
biliary drainage.

     PTC is a procedure to X-ray the hepatic and common bile ducts to
find the point of obstruction. It is followed by a surgical procedure
called percutaneous biliary drainage. A tiny cut is made into the skin
over the liver, and a small tube called a drain is placed into the blocked
bile duct to keep it open. The bile can then drain away into a bag outside
your body. A few days later, the drain will be removed and replaced by a
stent. This will allow the bile to drain internally, in the normal way.

   * Bleeding or a leak of bile internally are the most common
complications and occur in 3 to 5 patients in 100.

   * Resection
     Resection is the surgical removal of a diseased or damaged part of
the body. It normally involves major surgery.

Blockage of the stent

Once the stent has been in place for some time, it may get blocked itself,
and stop working. If this happens, you may experience some of the
following:

   * jaundice returns
   * ‘flu-like symptoms (aching and feeling shivery)
   * stomach pains

It is important to contact your GP or the hospital as soon as you start
feeling unwell. A blocked stent is normally easy to deal with, usually by
having either an ERCP or PTC, as explained above.