Obstruction of the Biliary Tract
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Date
2013-12-09
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Abstract
R. Darko
The obstruction of the biliary tree may be intrahepatic or extrahepatic. It may also be partial or complete. When obstruction is significant the classical symptoms of jaundice, pruritus, pale stools and dark urine are prominent. Most cases of intra hepatic bile duct obstruction are not amenable for surgical repair and therefore emphasis will be placed on extrahepatic bile duct obstruction.
Carcinoma of the head of pancreas is the commonest cause followed by a gall stone causing the biliary obstruction. There are four categories based on the behaviour of the jaundice.(a) Progressive jaundice (b) Fluctuating jaundice (c). Chronic continuous obstruction and (d), Segmental obstruction where the patient is usually not jaundiced.
Even though the clinical diagnosis is usually satisfactory investigations are important. The most important investigations include observing a high level of blirubin and alkaline phosphatise. Delineation of the common bile duct by ultrasonography is the initial investigation but other investigations are necessary. Magnetic resonance imaging is reliable.
Treatment may be palliative where the site of obstruction is bypassed or curative where the cause of the obstruction is removed.
Complications abound if adequate preparation is not done in the jaundiced patient.
The liver glycogen stores should be instituted by adequate intake of daily infusion of 10% dextrose for 3 to 4 days before operation.
Coagulopathy that occurs in the jaundiced patient is corrected by administration of parenteral Vit K1. To prevent post-operative renal failure it is important to ensure adequate pre-operative, intra-operative and post-operative hydration.