Severe Obstructive Jaundice Research Articles

Problems engendered by a “standard approach” to all patients with jaundice or biliary pain

An accurate preoperative diagnosis of biliary tract disease is essential for proper therapy of the patient with jaundice or unusual abdominal pain. Our analysis of fifty-five complex cases suggests that careful selection of preoperative diagnostic tests will allow an accurate preoperative diagnosis to be made. In patients with mild obstructive jaundice without obvious stones or carcinoma, retrograde cholangiography, physicochemical and cytologic analysis of bile, and arteriography should be performed. These studies should provide data that will make operation unnecessary or clearly indicated. In patients with severe obstructive jaundice, percutaneous transhepatic cholangiography is indicated. This technic can establish the presence and nature of a high ductal obstruction, can be converted for long-term therapeutic decompression, and will allow bile to be obtained for cytologic study and tissue to be obtained, by brush biopsy, for histologic examination. In patients in whom pain is the outstanding symptom, arteriography and retrograde cholangiography will most likely establish the diagnosis.

Hereditary lymphedema and obstructive jaundice

Abnormal lymphatic vessels of the lower extremities were demonstrated in 2 sisters who initially presented with severe obstructive jaundice with peripheral edema. Small lymphangiomas were present in 3 members of the paternal side of the family. A congenital defect in hepatic lymphatic vessels may account for the persistent hepatomegaly in children with this inherited syndrome.

Reconstructive analysis of the cholangiolar area in surgical jaundice: With reference to intractable jaundice after biliary drainage

<h2>Summary</h2> In specimens of the liver obtained from four patients with severe obstructive jaundice, the three dimensional structure of the cholangiolar system was studied by the method of image reconstruction from serial sections. In cases of persistent jaundice after biliary drainage, disruption of cholangioles with blind loop and fragment formation, stenosis, and discontinuities due to bile plugs were demonstrated. It was postulated that these findings represented the process of secondary intrahepatic cholestasis.

The Resident's Page

TEMPORAL BONE QUIZ CASE CHARLES W. GROSS, MD, BOSTON At the age of 74 this patient was seen for purulent discharge, of several weeks' duration, coming through a large epitympanic perforation in his right ear. A large dry epitympanic perforation was also noted in the left ear. The discharge subsided with antibiotic therapy, and a subsequent audiogram revealed a bilateral combined sensorineural and conductive loss (Fig 1). Roentgenograms indicated bilateral sclerotic mastoids without evidence of destruction. Three years later at the age of 77 he was admitted to the hospital with severe obstructive jaundice and found to have carcinoma of the pancreas. He died three weeks after an unsuccessful palliative operation. In the intervening three years he had had no further otorrhea but had been discovered to have diabetes and advanced atherosclerosis. This led to several operative procedures for peripheral vascular insufficiency and had precipitated a left middle cerebral artery

Prolonged Severe Obstructive Jaundice in Hodgkin's Disease

Prolonged Severe Obstructive Jaundice in Hodgkin's Disease

Prolonged Severe Obstructive Jaundice in Hodgkin's Disease

Summary A patient with Hodgkin's disease with marked elevation of both serum bilirubin and alkaline phosphatase values over a 441-day period of observation is reported. This patient was believed to have chronic hepatitis until autopsy revealed the true nature of his illness. However, even postmortem examination did not provide a completely satisfactory explanation for the exact cause of the jaundice. Although there was some enlargement of lymph nodes in the hilus of the liver, the bile ducts did not show changes usually seen in chronic bile duct obstruction. In addition, there was no demonstrable Hodgkin's infiltrate in the liver. Similar cases of Hodgkin's disease with poorly explained jaundice are reported in the literature. However, it is unusual for a patient with Hodgkin's disease to have such a marked elevation of serum bilirubin and alkaline phosphatase values over such a prolonged period of observation.

SEVERE OBSTRUCTIVE JAUNDICE DUE TO AMOEBIC LIVER ABSCESS

A case of amoebic liver abscess is reported in which it is clearly indicated that severe obstructive jaundice can be a predominant clinical feature of the condition. Other clinical manifestations of interest are discussed.

Renal Failure in Association With Severe Liver Diseases and Obstructive Jaundice (hepatorenal Syndrome)

Renal Failure in Association With Severe Liver Diseases and Obstructive Jaundice (hepatorenal Syndrome)

Giant cell hepatitis associated with hereditary spherocytosis

An infant with hereditary spherocytosis, treated by splenectomy, was found at autopsy to have giant cell hepatitis. The clinical picture was dominated by spherocytic anemia and severe obstructive jaundice. The presence of hepatitis was suspected but not seriously considered during life. The possible etiologic relationship between the two conditions is discussed. An infant with hereditary spherocytosis, treated by splenectomy, was found at autopsy to have giant cell hepatitis. The clinical picture was dominated by spherocytic anemia and severe obstructive jaundice. The presence of hepatitis was suspected but not seriously considered during life. The possible etiologic relationship between the two conditions is discussed.