Management of Obstructive Jaundice
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Questions and Answers

What is the first step in managing a patient with suspected obstructive jaundice?

  • Administer broad spectrum IV antibiotics
  • Discuss for admission and work-up in hospital (correct)
  • Perform surgical intervention immediately
  • Test INR levels immediately

    • Which antibiotic is suggested for patients with cholangitis who are allergic to Penicillin?

  • Augmentin
  • Clindamycin
  • Ciprofloxacin (correct)
  • Amoxicillin

    • What is the purpose of administering Vitamin K to patients with obstructive jaundice?

  • To control infection
  • To decrease pain levels
  • To improve renal function
  • To manage bleeding risk associated with elevated INR (correct)

    • What complication must be carefully monitored in patients with obstructive jaundice?

    <p>Dehydration leading to acute kidney injury</p> Signup and view all the answers

    What is the role of stents in managing obstructive jaundice?

    <p>To relieve obstructions in unresectable cases</p> Signup and view all the answers

    Which of the following procedures might be performed if a malignant lesion is deemed resectable?

    <p>Pancreatico-duodenectomy</p> Signup and view all the answers

    What is a common presentation indicating a patient has cholangitis?

    <p>Fever and rigors or raised white cell count</p> Signup and view all the answers

    What should be avoided in treating patients with obstructive jaundice who have cardiac conditions?

    <p>Intravenous fluids overload</p> Signup and view all the answers

    What is the preferred time frame for scheduling surgery (Cholecystectomy) for Acute Cholecystitis at TBH?

    <p>Within 3-4 days</p> Signup and view all the answers

    Which of the following is not an indication for urgent surgery for Acute Cholecystitis?

    <p>Jaundice due to bile duct obstruction</p> Signup and view all the answers

    What alternative policy was used in previous years for treating Acute Cholecystitis?

    <p>Medical therapy followed by elective surgery in 6 weeks</p> Signup and view all the answers

    What is a critically ill patient's treatment option if not fit for cholecystectomy?

    <p>Percutaneous cholecystostomy</p> Signup and view all the answers

    What is the prognosis for carcinoma of the gallbladder if discovered before spreading beyond the wall?

    <p>Best if incidentally discovered on histology</p> Signup and view all the answers

    What is indicated by perforation of the gallbladder?

    <p>Cholecystostomy is temporary</p> Signup and view all the answers

    Which of the following symptoms is associated with advanced gallbladder carcinoma?

    <p>Obstructive jaundice</p> Signup and view all the answers

    What is the outcome of untreated advanced gallbladder carcinoma?

    <p>Poor prognosis and minimal therapy options</p> Signup and view all the answers

    What is the primary management approach for patients suspected of having cholangitis?

    <p>Antibiotic administration and prevention of dehydration</p> Signup and view all the answers

    Which of the following is NOT a symptom commonly associated with cholangitis?

    <p>Nausea</p> Signup and view all the answers

    During the diagnosis of common bile duct stones, what ultrasound finding supports the diagnosis?

    <p>Dilation of the CBD greater than 7mm</p> Signup and view all the answers

    What should happen if a patient with suspected CBD stones shows relief of colic and normalization of bilirubin levels?

    <p>Schedule a same-admission laparoscopic cholecystectomy.</p> Signup and view all the answers

    Which component is NOT part of Reynold’s pentad in the context of cholangitis?

    <p>Abdominal distension</p> Signup and view all the answers

    What is one of the primary indications for performing a cholecystectomy in patients with gallstones?

    <p>To eliminate symptoms associated with gallstones</p> Signup and view all the answers

    What is the typical course of action for patients who do not show improvement in symptoms of cholangitis?

    <p>Schedule an ERCP to remove the CBD stone</p> Signup and view all the answers

    Which surgical procedure is preferred for the treatment of symptomatic gallstones?

    <p>Laparoscopic cholecystectomy</p> Signup and view all the answers

    What does the sensitivity of ultrasound for diagnosing common bile duct stones approximate?

    <p>40%</p> Signup and view all the answers

    What is a common complication associated with cholecystectomy?

    <p>Post-operative bleeding</p> Signup and view all the answers

    In patients managed for cholangitis, which test is considered unnecessary and expensive to repeat daily?

    <p>Full liver function tests</p> Signup and view all the answers

    What is the most common organism found in cases of acute cholecystitis?

    <p>Escherichia coli</p> Signup and view all the answers

    Which method is typically employed to manage acute cholecystitis according to established guidelines?

    <p>IV fluids, analgesia, and broad spectrum antibiotics</p> Signup and view all the answers

    What is a contraindication for cholecystectomy in symptomatic patients?

    <p>Poor performance status unfit for general anesthesia</p> Signup and view all the answers

    Which of the following antibiotics are recommended for treating acute cholecystitis?

    <p>Ciprofloxacin and Metronidazole</p> Signup and view all the answers

    Which condition may necessitate surgical intervention by bypassing the bile duct?

    <p>Chronic pancreatitis with biliary compression</p> Signup and view all the answers

    What characterizes mild cholangitis?

    <p>Patient responds well to antibiotics and IV fluid administration.</p> Signup and view all the answers

    Which of the following is a common management approach for severe cholangitis?

    <p>High-care setting with close monitoring, fluids, and antibiotics.</p> Signup and view all the answers

    What is a common presentation of intrahepatic cholangiocarcinoma?

    <p>Weight loss with right upper quadrant abdominal pain.</p> Signup and view all the answers

    Where do Klatskin tumors typically occur?

    <p>At the biliary confluence in the hepatic hilum.</p> Signup and view all the answers

    Which symptom is NOT typical of intrahepatic cholangiocarcinoma?

    <p>Jaundice.</p> Signup and view all the answers

    What could be a potential treatment conducted if a patient with severe cholangitis does not respond to initial treatment?

    <p>Cholecystostomy as a drainage option.</p> Signup and view all the answers

    Once diagnosed, how is cholangiocarcinoma typically managed?

    <p>Patients are staged and treatment assigned based on resectability and fitness.</p> Signup and view all the answers

    What is NOT a typical method for biliary drainage in severe cholangitis?

    <p>Laparoscopic cholecystectomy.</p> Signup and view all the answers

    Study Notes

    Management of Obstructive Jaundice

    • Admission and work-up necessary upon suspicion of obstructive jaundice; patients may be critically ill.
    • Resuscitation includes intravenous fluids, antibiotics, and analgesia.
    • Fever or raised white cell count indicates cholangitis; requires urgent treatment.
    • Broad-spectrum IV antibiotics (e.g., Augmentin, Ciprofoxacin, Metronidazole) administered for cholangitis.
    • Vitamin K (5-10mg IV) given if INR is elevated or jaundice is not relieved promptly.
    • Patients at risk of acute kidney injury must be carefully hydrated; avoid dehydration.
    • Interventions are required to relieve obstruction and address underlying causes (e.g., tumors).
    • Stents may be placed via ERCP or PTC for unresectable tumors or strictures due to conditions like chronic pancreatitis.
    • Surgical bypass may involve creating an anastomosis between bile duct and small bowel (Roux-en-Y Hepatico-jejunostomy).

    Symptomatic Gallstones

    • Symptoms typically precede complications such as acute cholecystitis and pancreatitis.
    • Indication for cholecystectomy arises once gallstones are confirmed as the cause of symptoms.
    • Laparoscopic cholecystectomy is the preferred treatment; contraindications include poor performance status and patient refusal.
    • Complications of cholecystectomy may include bleeding, bile leaks, and bile duct injuries.

    Management of Acute Cholecystitis

    • Diagnosis and severity based on Tokyo Guidelines; requires hospital admission, IV fluid resuscitation, and broad-spectrum antibiotics.
    • Opioids are typically required for pain relief.
    • Common organisms include E. coli and Klebsiella; treatment options include Augmentin and metronidazole.
    • Surgery (cholecystectomy) should be scheduled within 3-4 days; severe cases may require urgent intervention.
    • Critically ill patients may need percutaneous cholecystostomy as a temporary measure before surgical intervention.

    Carcinoma of the Gallbladder

    • Poor prognosis once spread beyond the gallbladder wall; best outcomes if discovered incidentally post-cholecystectomy.
    • Advanced disease commonly presents with jaundice or metastases; few treatment options available.

    Bile Duct Obstruction and Cholangitis

    • Obstruction results in obstructive jaundice; sepsis management parallels cholangitis protocols.
    • High risk of severe sepsis; antibiotics and hydration are crucial.
    • Common bile duct stones typically present with obstructive jaundice diagnosed via ultrasound.
    • Conservative management for suspected CBD stones; surgery planned once symptoms improve or after stone removal by ERCP.

    Cholangitis

    • Life-threatening condition; severity may not correlate with bilirubin levels.
    • Charcot's triad (fever, jaundice, abdominal pain) and Reynold's pentad (hypotension, confusion) are key diagnostic criteria.
    • Mild cholangitis managed with fluids, antibiotics, and symptom monitoring; severe cases require biliary drainage.

    Cholangiocarcinoma

    • Adenocarcinoma can occur in intrahepatic or extrahepatic bile ducts.
    • Intrahepatic cases often present with liver mass and abdominal pain, not jaundice.
    • Extrahepatic cases (perihilar or distal) present with painless obstructive jaundice.
    • Treatment involves assessing resectability and metastases post-diagnosis.

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    Description

    This quiz focuses on the management of patients with obstructive jaundice, including surgical biliary disease and gallbladder conditions. Participants will learn about the clinical presentation, necessary resuscitation efforts, and guidelines for management of these patients. It is aimed at healthcare professionals involved in patient care.

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