Obstructive jaundice

Impaction of a stone in the common bile duct (usually at the duodenal papilla) causes obstructive jaundice.

Clinical features:

• Jaundice
• Pruritis
• Dark urine
• Pale stools
• Preceding biliary colic

Investigations:

Ultrasound:

• Shows dilatation of the bile ducts
• May identify ductal stones

ERCP (Endoscopic Retrograde CholangioPancreatoGraphy):

• Confirms the dx
• Makes the distinction between a stone and other causes of obstructive jaundice

Mx:

• The rx of choice is ERCP and extraction of the ductal stone(s) after division or dilatation of the sphincter of Oddi
• Subsequently (if it has not been done already) the gallbladder should be removed unless the pt is elderly or at a high operative risk