Cases Of Jaundice Research Articles

Biliary tract schwannoma:A rare case of obstructive jaundice in a middle aged gentleman.

Schwannomas are derived from Schwann cells, the most common sites being upper extremiteis, trunk, retroperitoneum, head and neck, mediastinum. However they can arise from the gastrointestinal tract too, including the biliary system. We present a case of a 40 year old gentleman, who presented with obstructive jaundice whose computed tomography of the abdomen was suggestive of mass lesion at the porta causing intra hepatic biliary radicle dilatation. And MRCP s/o similar findings with an endosonography s/o hydatid cyst. He underwent local resection with biliary enteric reconstruction and the histopathological examination confirmed a biliary duct schwannoma. On follow at 6 months, the patient is a symptomatic and shows no signs of recurrence. We have also reviewed the literature of biliary tract schwannomas.

Bedside ultrasound in a Jaundice patient by emergency physicians

Purpose: Abdominal ultrasound has proven to be a useful, safe, versatile, with appropriate experience, help earlier diagnosis and comprehensive management of patients seen in the emergency department. We present a case of Jaundice by biliary stent obstruction in patient with pancreatic neoplasia, through a bedside ultrasound by Emergency Physicians.

Evaluating Nursery Phototherapy Use and Discharge Practices After the Creation of a Weekend Newborn Clinic.

Neonatal jaundice has been reported for centuries and remains one of the most common newborn concerns, with nearly two-thirds of infants having jaundice in the first week of life.1 Although most cases of jaundice are nonthreatening, many infants require treatment with phototherapy. Incidences of significantly high levels still remain, placing infants at risk for kernicterus, a rare but often preventable cause of permanent neurologic impairment. Bilirubin levels peak at 3 to 5 days of life, but with early infant discharges and barriers to establishing consistent follow-up care, physicians are challenged to determine which babies will go on to have pathologic jaundice requiring further intervention.2 The American Academy of Pediatrics (AAP) addressed this issue of newborn jaundice in 2004 and updated its stance in 2009, with a clinical practice guideline that recommends all well newborns receive a screening bilirubin level before discharge, with results interpreted using a specific risk nomogram (Fig 1).2,3 On the basis of this algorithm, newborns who have bilirubin levels falling within the high-risk or high/intermediate-risk zones but do not require phototherapy may be discharged. These infants, however, should have a follow-up evaluation within 24 or 48 hours, based on the specific risk zone. This recommendation may be altered depending on the presence of associated risk factors (Fig 2). The guideline further states that if appropriate follow-up cannot be arranged for such babies, for example, because of lack of outpatient clinic hours on weekends and holidays, the discharges should be delayed until their risk factors have diminished. FIGURE 1 Risk designation of term and near-term well newborns based on hour-specific serum bilirubin values; used to interpret discharge bilirubin levels to predict babies at risk for levels that rise above the 95th percentile. (Reproduced with permission from the AAP and Bhutani VK, Johnson L, Sivieri …

116 Systematic childbirth at 37–39 weeks in preeclampsia with no signs of severity: Maternal and neonatal outcomes

Introduction Systematic delivery term in preeclampsia can reduce risks, identify maternal and neonatal outcomes contributing to the adoption of this strategy worldwide. Objective Evaluate maternal and perinatal outcomes at 37 – 39 weeks with systematic delivery in preeclampsia with no signs of severity, comparing pregnancies with no comorbidities. Method A retrospective study of 1471 women who gave birth at the Guilherme Alvaro Hospital (Santos / Brazil), from January/2014 to January/2015. Data were collected from records of all deliveries. The inclusion criteria for the study group were: pregnancies with a single live fetus, gestational age 37–39 weeks in patients with “pure” or superimposed preeclampsia with no signs of severity (NHBPEP, 2000). Exclusion criteria were multiple births, gestational age less than 37 or more than 39 weeks, with severe preeclampsia and incomplete records. The control group included: pregnancies with a single live fetus, gestational age 38 – 40 weeks with no hypertension or other comorbidities, after normal deliveries of spontaneous onset. Exclusion criteria were twin pregnancies, gestational age less than 38 or more than 40 weeks, cesarean sections, forceps deliveries, induced vaginal deliveries, incomplete records, presence of collagen, clinical or gestational diabetes, smoking, fetal malformations, alloimmunization and infections. For the numerical variables of the research the Student’s t test was used and for the statistical analysis the Fisher’s exact test. The significance level was p Results 88 records were selected (44 in the study group/44 in the control group). Both differed regarding the variables: maternal age and gestational age at delivery, previous cesarean, type of delivery, days of hospitalization and maternal complications in the postpartum period. 50% of the women in the study group were induced at the beginning of labor but only ten pregnancies evolved to normal delivery. The following neonatal complications weren’t present: sepsis, periventricular hemorrhage, meconium aspiration syndrome, bronchopulmonary dysplasia, and any need for intubation or cardiac massage. There was just one case of pathological jaundice in each group.

Interesting Cause of Obstructive Jaundice Diagnosed by Endoscopic Ultrasound

Hepatobiliaryascariasis is a common problem in tropical countries including India. It can present with intermittent symptoms and fluctuating imaging results and blood parameters as the worm migrates within the gastrointestinal tract. Patient can present with biliary colic, obstructive jaundice, ascending cholangitis, acalculouscholecystitis or acute pancreatitis. We present a case of obstructive jaundice in a 37 years old female, post cholecystectomy status. Patients abdominal ultrasound was apparently normal 1 week before jaundice, which was done for abdominal pain. Biliary ascariasis was diagnosed using endoscopic ultrasound (EUS). A live adult ascaris was removed from common bile duct (CBD) by endoscopic

Is screening for urine infection in well infants with prolonged jaundice required? Local review and meta-analysis of existing data

BackgroundThe National Institute for Health and Care Excellence (NICE) neonatal jaundice guidance recommends a urine culture for investigation of babies with prolonged jaundice. However, the evidence cited for this guidance...

Management Malaria with Jaundice

Malaria is the most important parasitic disease in the world related to high morbidity and mortality. Jaundice is one of the common manifestation of severe malaria in adults and its incidence vary from 10-45% in different regions. Presence of jaundice in malaria indicates a more severe illness with higher incidence of complication. Jaundice plus evidence of other vital organ dysfunction vital as one of manifestation of severe malaria based on WHO guideline 2010. Jaundice in severe malaria caused by multi factorial and can result from haemolysis of parasitized and nonparasitized red blood cell, hepatic dysfunction and possibly an element of microangiopathic haemolysis associated with disseminated intravascular coagulation. Awareness of malaria biliosa is important to prevent complication and mortality. Death from severe malaria often occurs within hours of admission to hospital or clinic, so it is essential that therapeutic concentrations of a highly effective antimalarial are achieved as soon as possible. Management of severe malaria comprises four main areas: clinical assessment of the patient, specific antimalarial treatment, adjunctive therapy and supportive care. Many trials are consistent and suggest that artesunate is the treatment of choice for adults with severe malaria. Management of malaria biliosa is not different from management the other severe malaria. Here we report one case of jaundice in falciparum malaria (malaria biliosa). There was problematic in management but the treatment malaria with jaundice with adequate dose of artesunate injection improved patient’s health status and parasitological improvement.

Interference of Vaccine Derived Polio Viruses with Diagnosis of Enteroviral Diseases in Neonatal Period.

Enteroviruses (EV) are a common cause of neonatal sepsis especially at the junction of summer and fall. This study was planned to find the frequency of Enteroviral (EV) sepsis among neonates with clinical sepsis. This is a prospective descriptive study. Rectal and pharyngeal swab samples were taken from all neonates with clinical sepsis and a control group of neonates with simple jaundice. EV was confirmed by both cell culture and RT-PCR. Anti polio antiserum was used to differentiate Polioviruses from Non Polio EVs (NPEV). We had 67 neonates with clinical sepsis and 31 cases of simple jaundice during 105 days. NPEVs were isolated from 2 cases (2.9%) of the sepsis arm and one neonate (3.2%) of the jaundice group. Polio virus was isolated from 16.2% and 15.3% of OPV recipients in the sepsis and jaundice group respectively. Enteroviruses were not a common cause for neonatal sepsis in Nemazi hospital at the time of this study. OPV vaccinated neonates commonly pass the vaccine virus in their pharynx and stool which can be mistaken with NPEV.

Etiological spectrum of recurrent jaundice in adults: A retrospective observational study from a tertiary care center

Introduction: Studies regarding etiological spectrum of recurrent jaundice are rare. We conducted this study to identify the causes of recurrent jaundice in a tertiary care center. Materials and Methods: Frequency of different causes of recurrent jaundice was assessed from 130 patients attended General Medicine Department over a period of 3 years. Recurrent jaundice was considered when patients had more than one episodes of jaundice with serum bilirubin ≥3 mg/dl since childhood. Recurrent jaundice was diagnosed from past medical records, records of follow-up visits, and current clinical presentation. Causes were identified from past and present medical records of history, clinical and laboratory examinations. Results: Causes of recurrent jaundice included prehepatic (30%), hepatic (59.23%), and posthepatic (10.77 %) disorders. Prehepatic disorders were Gilbert's syndrome (GS), megaloblastic anemia, autoimmune haemolytic anemia, Wilson's disease, G6PD deficiency, etc. Hepatic disorders were exacerbations of alcoholic hepatitis, hepatitis B and C, autoimmune hepatitis, congestive cardiac failure, sarcoidosis, benign recurrent intrahepatic cholestasis, eclampsia, pregnancy induced cholestasis, falciparum malaria, drug induced liver injury (DILI), etc. Posthepatic causes were choledocholithiasis, recurrent pancreatitis, periampullary carcinoma, choledochal cyst, ascariasis, hemobilia, HIV cholangiopathy, autoimmune pancreatitis, etc. Prehepatic jaundice cases were younger. The highest level of total bilirubin was seen in alcoholic hepatitis, DILI, and hepatitis B. Alcoholic hepatitis was the most common cause of recurrent jaundice (19.23%). GS was the most common prehepatic cause. Mean age was lowest in GS and highest in DILI. Conclusion: Etiological spectrum of recurrent jaundice includes many prehepatic, hepatic or posthepatic disorders. A larger study may enlarge the spectrum.

Obstructive Jaundice Caused by Tuberculous Lymphadenopathies

Although pulmonary tuberculosis is known to be the most common type in tuberculosis, it actually can affect any organ system. However, abdominal type is very rare among the extra-pulmonary types, and obstructive jaundice caused by lymphadenopathies due to tuberculosis is especially uncommon manifestation even in endemic areas. Tuberculous lymphadenopathies can mimic lymphadenopathies by other metastatic tumors or lymphoma, thus early correct diagnosis is very important for avoiding unnecessary surgical interventions. Here, we reported two cases of obstructive jaundice caused by tuberculous lymphadenopathies. Both were treated with anti- tuberculosis medications and endoscopic retrograde biliary drainage without surgery.

Epidemiological investigation of a jaundice outbreak in Kishangarh, Rajasthan, India, 2014

Aim To study the distribution of jaundice cases among university students and clinical profile of positive cases to initiate the control measure inside university premises.

Tissue Diagnosis of Pancreato-Biliary Malignancies: Role of Brush Cytology, Bile Cytology, CA19.9, Cholangioscopy, and Cholangioscopic Biopsy

Introduction: Tissue diagnosis of pancreatobiliary malignancies has always been a challenging task. Various methods, which have been used for pre-operative diagnosis like endoscopic brush cytology, EUS FNA, have shown poor yield.Moreover imaging and tumour markers have also not been precise. Methods: We conducted a retrospective analysis of consecutive cases of malignant obstructive jaundice which were referred to us for ERCP and biliary stenting from april 2013 to march 2015. ERCP and appropriate tissue sampling followed by biliary stenting was done.CA19-9 assays were also done in majority.Last 10 cases were subjected to cholangioscopy.Cytology data was compared to clinical, radiological and surgical diagnosis. Results: 102 cases were referred for ERCP out of which 15 had hilar block involving the confluence hence were taken up for PTBD,4 had operable lesion hence taken up for surgery and 5 had CBD stones masquerading as malignant stricture where CBD clearance was done. Rest 78 where ERCP was done formed the study group.This included 35 cases of CholangioCA,19 Ca GB and 24 pancreatic tumours.in 48 brush smear in 28 bile and in 2 spy bite was taken.Cytology was positive for malignancy in 34,negative in 20 & indeterminate in 24.On further analysing the indeterminate,14 finally confirmed as malignancy & 6 were benign. The diagnostic yield was 61.5%(48/78), It was more for Brush smear 70%(34/48) vs bile 50%(14/28). Cholangioscopy was suggestive of malignancy in 8/10.spybite was taken in 2,both were positive. But we switched over to brush cytology as we found cholangioscopic forceps difficult to use.CA19.9 levels were available in 30 of 48 confirmed cases and were >500 in 20, 100-500 in 2, 35-100 in 6 and normal in 2,but were also raised to >500 in 4/5 cases with CBD stones. Conclusion: It is known that yield of biliary cytology during ERCP is around 30-50% in various studies. Factors which favour a positive result are older age,longer stricture and presence of a mass. our study showed a higher yield of brushings probably because we take brush after dilatation of stricture, without injecting contrast (air cholagiogram guided) and that we have an onsite pathologist. We conclude that brush cytology is a good tool and diagnostic yield is 70%.Very high levels of CA19.9 are suggestive but can not be relied upon as sole evidence of malignancy.Cholangioscopic images strengthen the diagnosis but cholangioscopic biopsy is not a practical tool as passage through scope is dificult and time consuming

An Interesting Case of Painless Jaundice: Primary Hepatic Lymphoma

An Interesting Case of Painless Jaundice: Primary Hepatic Lymphoma

Treatment Options of Lemmel’s Syndrome: A Case of Benign Obstructive Jaundice in The Elderly

Lemmel’s syndrome, also known as duodenal diverticulum obstructive jaundice, is a rare cause of benign obstructive jaundice that should be included in the differential diagnosis of biliary obstruction when PAD is present, in the absence of cholelithiasis or other detectable obstacle. Diagnosing Lemmel’s syndrome could be challenging, but being aware of this condition is important to avoid mismanagement and it begins with identification of PAD, while interpreting any bile duct imaging. It can be misinterpreted as periampullary tumors, biliary stones, or pancreatic pseudocyst. Symptomatic patients can be successfully managed endoscopically in many cases but surgical management would be necessary in selected cases.We present a patient with benign obstructive jaundice caused by Lemmel’s syndrome who was successfully treated with endoscopic sphicterectomy. A 67 years old female presented to the emergency department with chief complaint of jaundice. The patient was assesed to have obstructive jaundice cause by a duodenal mass, elevation of transaminase enzime supected caused by drug induced liver injury, hypertension (controlled), and anterior extensive coronary ischemia. Endoscopic retrograde cholangiopancreatografi (ERCP) showing mutiple giant diverticle in second part of duodenum, stenosis of the distal CBD with compression of diverticular extra luminal as a differential diagnosis. Endoscopic ultrasound (EUS) was performed to exlude a periampullary tumor, resulting distal CBD stenosis due to compression of multiple periampullary diverticula (PAD). We performed an endoscopic sphinterectomy (EST) and the stent was removed. A further evaluation of the tuberculous lymphadenitis was planned as outpatient setting. One month follow-up, no recurence of jaundice was observed.

Immunohistochemical characterization of the regenerative compartment in biliary atresia: a comparison between Kasai procedure and transplant cases

Biliary atresia (BA) accounts for most cases of pathologic infantile jaundice, which may lead to cirrhosis and eventually necessitate liver transplantation (LT). A cardinal histologic feature of BA is ductular reaction (DR), reflecting activation of the regenerative compartment in liver. We examined the immunohistochemical attributes of the progenitor cell population and its immediate descendants in BA patients undergoing Kasai procedure (KP) or LT. The BA cases were divided into those undergoing KP (n = 24) and those undergoing LT (n = 64). Immunohistochemistry for CD56, CK7, and CK19 was performed. Patients with BA (both KP and LT groups) had more DR than controls (scores 2.4, 2.2, and 0.1, respectively; P < .001), but the degree of DR did not differ between BA patients undergoing KP compared to LT. There was significantly more CD56 staining in DR in LT (2.5) versus KP samples (1.3; P < .001), with a trend toward the same pattern in hepatocyte progenitor cells in these samples (0.6 versus 0.2; P = .05). In intermediate hepatocytes, CK7 staining was higher in LT versus KP samples (1.7 versus 0.3; P < .001). No differences in CK19 staining were noted in the cell types in different BA groups. Immunohistochemistry suggests that the regenerative compartment is expanded in patients undergoing LT for BA, compared to patients with an earlier stage of disease undergoing KP. These observations support the notion that there is more active regeneration in livers with advanced-stage BA and highlight the immunophenotypic heterogeneity of progenitor cells in different phases of the disease.

Analysis and research on the application of the comprehensive nursing intervention in 180 cases of jaundice in premature children

Objective To explore the clinical effect of the comprehensive nursing intervention on premature children with jaundice. Methods 180 cases of premature children which were suffered from jaundice during 2009.12- 2011.12 were selected as subjects and were randomly divided into control and observation groups. Children in the control group(n= 90) were given conventional treatment and care, and in the observation group(n= 90) were given comprehensive nursing intervention with abdominal massage and enema on the basis of conventional treatment and care. Jaundice occurrence, duration and regression time, 1 d, 3 d, 5 d serum bilirubin values and bowel movement, defecation time and shape were compared between the two groups. Results The emergence time of jaundice was(2.2±0.9) d in control group, which was significantly less than that of observation group(4.4±1.6)d. The duration and regression of jaundice of control group were significantly longer than those of the observation group. The 1 d, 3 d, 5 d serum bilirubin values(unit:μmol/ L) of control group were respectively(49.9±15.5),(122.6±28.9)and(199.9±37.7), and 1 d, 3 d, 5 d serum bilirubin values(unit:μmol/ L) of the observation group were respectively(51.1±16.7),(86.8±19.8)and(121.1±22.5). There were no significant difference between the two groups in 1 d serum bilirubin(P> 0.05), there was significant difference in 3 d and 5 d serum bilirubin between two groups(P< 0.01). There were significant differences in the first meconium exclude, the first defecation turn yellow time and the daily number of bowel movements between two groups(P<0.05, P<0.01). Conclusions The comprehensive nursing intervention in preterm children has good clinical effect, which should be promoted and widely used. Key words: Comprehensive nursing intervention; Preterm children; Jaundice; Clinical effects

Neonatal Cholestasis - Differential Diagnoses, Current Diagnostic Procedures, and Treatment.

Cholestatic jaundice in early infancy is a complex diagnostic problem. Misdiagnosis of cholestasis as physiologic jaundice delays the identification of severe liver diseases. In the majority of infants, prolonged physiologic jaundice represent benign cases of breast milk jaundice, but few among them are masked and caused by neonatal cholestasis (NC) that requires a prompt diagnosis and treatment. Therefore, a prolonged neonatal jaundice, longer than 2 weeks after birth, must always be investigated because an early diagnosis is essential for appropriate management. To rapidly identify the cases with cholestatic jaundice, the conjugated bilirubin needs to be determined in any infant presenting with prolonged jaundice at 14 days of age with or without depigmented stool. Once NC is confirmed, a systematic approach is the key to reliably achieve the diagnosis in order to promptly initiate the specific, and in many cases, life-saving therapy. This strategy is most important to promptly identify and treat infants with biliary atresia, the most common cause of NC, as this requires a hepatoportoenterostomy as soon as possible. Here, we provide a detailed work-up approach including initial treatment recommendations and a clinically oriented overview of possible differential diagnoses in order to facilitate the early recognition and a timely diagnosis of cholestasis. This approach warrants a broad spectrum of diagnostic procedures and investigations including new methods that are described in this review.

Stauffer’s Syndrome Variant as an Unusual Case of Painless Jaundice

Stauffer’s Syndrome Variant as an Unusual Case of Painless Jaundice

Cesárea programada y morbilidad neonatal

OBJETIVO: Determinar la morbilidad de recién nacidos por cesárea programada. DISEÑO: Estudio retrospectivo, descriptivo, comparativo, transversal y analítico. MATERIALES Y MÉTODOS: Se revisa 102 casos de recién nacidos de gestantes con partos por cesárea programada atendidos en el Servicio de Obstetricia del Hospital III Essalud "Félix Torrealva Gutiérrez" de la ciudad de Ica, en el período comprendido entre el 1 de enero de 2000 y el 31 de diciembre de 2003. Se les comparó con un número similar de nacidos de parto eutócico. RESULTADOS: En el período estudiado, se atendió 3780 partos, de los cuales 102 fueron por cesárea programada. La edad materna mayor correspondio en 36,3% al grupo etáreo de 35 a 40 años, 70 (70,6%) eran casadas, 51,9% empleadas, 46,1% primigestas. El Ápgar del recién nacido fue &gt;=7 en 96,7% de neonatos, no hubo caso de asfixia severa; 58,8% fueron varones, 70,6% con peso adecuado. Se encontró 27,5% de casos de ictericia fisiológica, 17,7% con síndrome de dificultad respiratoria II y 7,8% con trastornos metabólicos, mientras en el grupo control fueron 6,9%, 4,9% y 3,9% respectivamente; en el grupo control, los traumatismos obstétricos fueron 6,9 y sólo 0,9% en el grupo de estudio. CONCLUSIONES: Existió relación entre morbilidad y la vía del parto; el riesgo de enfermedad fue mayor para los neonatos nacidos por cesárea programada.

Percutaneous Transhepatic Cholangiography and Intraductal Radiofrequency Ablation Combined with Biliary Stent Placement for Malignant Biliary Obstruction

PurposeTo determine the safety and feasibility of percutaneous transhepatic cholangiography (PTC) and intraductal radiofrequency (RF) ablation combined with biliary stent placement for malignant biliary obstruction. Materials and MethodsData from patients with unresectable malignant biliary obstruction who underwent PTC, intraductal RF ablation, and biliary stent placement (n = 12) or PTC and biliary stent placement only (control group; n = 14) were reviewed. Postoperative complications, jaundice remission, and stent patency were assessed. ResultsAll procedures were successful. No severe complications (eg, biliary bleeding, perforation) occurred. Two experimental group patients developed cholangitis, which resolved with conservative treatment. The 1-week jaundice remission and 3-month stent patency rates were similar in both groups, but the 6-month stent patency rate was higher in the experimental group (P < .05). In the experimental group, one death occurred as a result of gastrointestinal hemorrhage (unrelated to stent placement) by 3 months, and there were two cases of recurrent jaundice by 6 months. The latter two patients underwent repeat PTC, ablation, and stent placement. In the control group, one death occurred as a result of hepatic failure caused by progressive jaundice at 3 months, and another death resulted from disseminated intravascular coagulation caused by jaundice recurrence at 138 days after stent placement. In addition, seven patients developed jaundice recurrence (50–151 d after stent placement). PTC and repeat stent placement were performed in these patients. ConclusionsPercutaneous transhepatic cholangiography and intraductal RF ablation combined with biliary stent placement for malignant biliary obstruction is safe and feasible and effectively prolongs stent patency time.