Jaundice is always a pathological sign on most occasions, so that it should never be
ignored. It includes 3 types: haemolytic, hepatocellular and cholestatic (obstructive).
Cholestatic jaundice can be classified into two broad categories: intrahepatic and
extrahepatic; Intrahepatic cholestatic jaundice is due to impaired hepatobiliary
production and excretion of bile causing bile components to enter the circulation. The
concentration of conjugated bilirubin in serum is elevated in cholestatic jaundice.
Intrahepatic cholestasis may be due to primary biliary cirrhosis, hepatocellular disease
such as acute viral hepatitis infection, drug-induced liver injury ,Dubin-Johnson
syndrome, Rotor syndrome, or cholestatic disease of pregnancy. Wilson's disease may also
lead to intrahepatic cholestasis due to copper deposition into liver parenchyma, with
further hepatocellular dysfunction, and jaundice.1 Extrahepatic cholestasis may be the
result of benign causes including choledocholithiasis (is the most frequent cause),
primary sclerosing cholangitis, Mirrizi syndrome, postoperative billiary stricture, post
inflammatory stricture, pancreatitis, choledochal cyst, pyogenic cholangitis, parasitic
diseases, duodenal diverticulosis and AIDS cholangiopathy.2 While malignant causes
include cancer head of pancreas, carcinoma of the gall bladder cholangiocarcinoma,
carcinoma of the duodenum, ampullary tumors, hepatocellular carcinoma, lymphoma and
metastatic tumors.3 Today's obstructive jaundice is more of a medical entity since
gastroenterologists, rather than surgeons, handle the majority of obstructive jaundice
cases with ERCP or stenting.4 Obstructive jaundice patients typically complain of
jaundice, yellowish discoloration of skin and eyes, pruritus, clay colored stool,
dark-colored urine and aneroxia.5 Jaundice in choledocholithiasis is intermittent and
associated with pain.6-7 Malignant jaundice commonly presents with persistent and
progressive painless jaundice, often accompanied by weight loss, anemia, and abdominal
mass.6-8 Patients with obstructive jaundice are susceptible to developing deficiencies in
nutrition, infectious complications , acute renal failure, and compromised cardiovascular
function. Other adverse events , like endotoxemia, hypovolemia, and coagulopathy, can be
subtle and dramatically raise mortality and morbidity.9 A combination of many approaches,
such as the patient's history, physical examination, biochemical tests, and imaging are
needed. Abdominal ultrasonography, the first-line imaging modality used for the diagnosis
of obstructive jaundice because it is noninvasive, fast and widely accessible.10 However,
it is necessary to combine ultrasonography with other imaging techniques such as;
computed tomography (CT), endoscopic ultrasonography (EUS) or magnetic resonance
cholangiography (MRCP) to establish local and distant complications and make a choice of
the right therapeutic approach.11 also liver biopsy, as well as observation of patient's
course, can lead to an accurate diagnosis.
Early and precise detection of etiology of obstructive jaundice can help to manage such
patients and thus will enhance the patient's quality of life and increase the survival
rate of patients with malignant pathology.12