Obstructive jaundice (summary)

This is a basic article for medical students and other non-radiologists

Obstructive jaundice represents a set of conditions that cause jaundice by obstructing the flow of bile into the duodenum anywhere along the intrahepatic or extrahepatic biliary tree.

Reference article

This is a summary article; read more in our article on jaundice.

Summary

• epidemiology
  • depends on the underlying cause
• presentation
  • icterus of skin or sclera (actually conjunctival! ¹)
  • itch may be a presenting complaint
  • depending on the cause
• pathophysiology
  • broadly split into benign and malignant causes
    • benign
      • gallstones (choledocholithiasis)
      • stricture, e.g. primary sclerosing cholangitis
      • external compression, e.g. pancreatic pseudocyst
    • malignant
      • head-of-pancreas carcinoma
      • portal lymphadenopathy
      • other cancer, e.g. cholangiocarcinoma, gallbladder carcinoma
• investigation
  • ultrasound is almost always the best first test
  • cross-sectional imaging may be helpful, but depend on US findings
• treatment
  • depends on the underlying cause

Role of imaging

• confirm biliary dilatation
• determine the level of obstruction
• if there is a mass
  • characterize the mass lesion
  • look for local invasion or distant spread

Radiographic features

Ultrasound

Ultrasound is the first line investigation for the assessment of jaundice. It is a quick and cheap test and effective in diagnosing biliary dilatation in the hands of an experienced operator. It can also help characterize lesions and determine the level of obstruction.

MRI

MRCP (MR cholangiopancreatography) is a specific type of MRI of the abdomen. It looks specifically at the fluid within the biliary tree and is very helpful when determining the level of biliary obstruction.

MRI Liver can be performed to characterize liver lesions and requires the use of IV contrast.

CT

CT is used for the assessment of extrahepatic mass lesions that cause biliary obstruction and also to determine if there is distant spread in suspected malignancy.