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jaundice (icterus)

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a diagnostic approach to the adult patient with obstructive pattern of abnormal LFT's

  • if pain, fever and jaundice then Mx as per ascending cholangitis until proven otherwise
  • if relatively well then
    • nil orally
    • iv fluids
    • FBE, U&E, LFT's, lipase, clotting
    • fluid balance chart
    • Rx coagulopathy with vitamin K
    • admit under surgical unit

early abdominal USS within 24hrs if possible

normal USS - no mass, no stones, CBD not dilated

  • consider alternative diagnoses
  • refer to gastroenterology
  • consider CT-IVC, MRCP or EUS but these are generally low yield in this scenario

cholelithiasis detected

  • ERCP/sphincterotomy +/- cholecystectomy

dilated CBD, no cholelithiasis detected but biliary or pancreatic lesion, or bilirubin > 200

  • CT pancreatic protocol
  • tumour markers (CEA, CA19.9)
  • refer to upper GIT surgical meeting for discussion
  • if suitable for operative Mx, consider pre-op drainage as below
  • if not suitable for operative Mx then biliary drainage via either:
    • ERCP + metal stent
    • PTC

dilated CBD but no cholelithiasis seen and no mass and bilirubin < 200

  • requires further imaging:
    • if bilirubin < 30 then CT-IVC
    • if bilirubin > 30 then MCRP, or if no access to MRI then consider CTAP
    • if cholelithiasis detected Mx as above for cholelithiasis
    • if still no cholelithiasis detected then cholecystectomy may be indicated
jaundice.txt · Last modified: 2013/08/18 09:04 by

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