Diagnostic Ultrasound in the Differentiation between Obstructive Jaundice and Non-Obstructive Jaundice

Abstract

Although the great Rokitansky described the pathological findings in obstructive jaundice in 1846 in his Handbook of General Pathological Anatomy, the practical usefulness of this knowledge was not apparent until the 1890’s . At that time, surgical techniques were being developed which could relieve obstructive jaundice. The diagnostic dilemma that arose then between obstructive and non-obstructive jaundice continues to the present day. Based on recent literature and our own experience, we feel that diagnostic ultrasound is an exceptionally useful tool in making the distinction between obstructive and non-obstructive jaundice. The changes in anatomy that accompany obstructive jaundice (potentially demonstrable by ultrasound), include dilatation of intrahepatic bile ducts, gallbladder and the common bile duct. We are aware of no data in the available literature that would tell us what duration or degree of obstruction is necessary to cause intra-hepatic bile duct, gallbladder or cornmon bile duct dilatation that is clearly more than occurs in any physiological state. Basic physiology studies tell us that the secretion of bile is an energy requiring process which can procede against a back pressure up to 20 to 23 mm Hg.