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What causes it?
It is caused by a blocked bile duct. This leads to the build-up of a natural, body waste-product called bilirubin. Bilirubin is made as part of the body’s way of getting rid of dead blood cells. Normally, it is disposed of by the liver, becoming part of the green bile liquid that the liver produces. From the liver, the bile is drained away through the common bile duct, which connects the liver to the small intestine.
However, with obstructive jaundice, a blockage in the bile duct means that the bilirubin cannot be removed, and stays in your blood stream. The level of bilirubin in your blood and tissues rises. It is carried to your skin and eyes, and tints them yellow.
What is obstructive jaundice?
Obstructive jaundice is yellowing of the skin or whites of the eyes. The condition turns your urine dark, and makes your stools pale. You may also experience:
- Sleepiness
- Extreme tiredness
- Sickness
- Itchy, dry skin
Your doctor will want to investigate the cause of the blockage. To do this, an ultrasound scan or CT scan will be arranged, to get a picture of the blood flow to and from your liver.
The causes of obstructive jaundice range from less serious conditions like gallstones, through to more worrying conditions like pancreatic cancer. This will need to be established so that your doctor can choose the correct treatment for it, and treat the underlying condition.
How is it treated?
There are three ways of relieving the blockage that is causing the jaundice. The first two procedures listed below are temporary measures. They will help clear the jaundice while its cause is being established. The third procedure, resection, is only suitable once the cause has been found, and its use depends on what the cause is.
- ERCP (Endoscopic Retrograde Cholangio Pancreatography)
In this procedure, a type of instrument for looking inside the body, called an endoscope, is used. It is a thin, telescopic tube, with a light and a small camera on the end of it. It is passed through your mouth, through your stomach, and into the first part of your small intestine. During the procedure, a small tube, like a straw (called a stent), is placed into the blocked bile duct to make a passage-way. The stent allows the bile from your liver to flow freely into your small intestine again, and so relieve the jaundice.
Beforehand, you will be given some sedation to ensure that you feel no pain.
The procedure may be complicated by bleeding, damage to the bowel, infection or pancreatitis (inflammation of the pancreas). One in a hundred patients experience serious complications.
- PTC (Percutaneous Transhepatic Cholangiography) and percutaneous biliary drainage.
PTC is a procedure to X-ray the hepatic and common bile ducts to find the point of obstruction. It is followed by a surgical procedure called percutaneous biliary drainage. A tiny cut is made into the skin over the liver, and a small tube called a drain is placed into the blocked bile duct to keep it open. The bile can then drain away into a bag outside your body. A few days later, the drain will be removed and replaced by a stent. This will allow the bile to drain internally, in the normal way.
- Bleeding or a leak of bile internally are the most common complications and occur in 3 to 5 patients in 100.
- Resection
Resection is the surgical removal of a diseased or damaged part of the body. It normally involves major surgery.
Blockage of the stent
Once the stent has been in place for some time, it may get blocked itself, and stop working. If this happens, you may experience some of the following:
- jaundice returns
- ‘flu-like symptoms (aching and feeling shivery)
- stomach pains
It is important to contact your GP or the hospital as soon as you start feeling unwell. A blocked stent is normally easy to deal with, usually by having either an ERCP or PTC, as explained above.
Further Information
You will be able to get more information about jaundice and your condition from your consultant or from your specialist nurse.
