Obstructive jaundice is characterised by yellow discolouration of the skin and scleræ due to hyperbilirubinaemia. Icterus is the technical tern for jaundice, which may be caused by other mechanisms.
Obstruction of the biliary system leads to failure to clear bilirubin through the GIT (urobilinogen > stercobilinogen > stercobilin; some urobilinogen is reabsorbed and transported to the kidneys where it is converted to urobilin and excreted)
Causes
Choledocholithiasis
Obstruction of the biliary tree and/or common hepatic duct by gall stones leads to lack of bile release and retention of bilirubin.
Hallmarks of choledocholithiasis are colicky non-peritonitic RUQ pain (or central abdominal pain typically associated with a desire to writhe), especially following fatty meals, and a negative Murphy’s sign, as well as steatorrhoea and N&V.
ERCP is used for both diagnosis and treatment for gallstones and is usually successful, in some cases where stones cannot be removed a stent can be placed to hold the duct patent. MRCP may be indicated in patients where ERCP is unsuccessful or where imaging is indicated to visualise stones.
Pancreatic Cancer
Obstructive jaundice can be caused by compression of the biliary system due to tumour of the pancreas. It shares many of the same general symptoms as choledocholithiasis, however abdominal pain is usually absent. Biliary obstruction accounts for the signs and symptoms of this condition. It usually arises from tumour of the head and neck of pancreas where is surrounds/opposes the common bile duct.