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06-06-2008, 02:34 PM
Aetiology:
1- Pancretic carcinoma
ÄCA head of pancreas. Ä Periampullary carcinoma.
2- 2ry L.N. at porta hepatis.
3- Malignancy of the liver
Ä 2ries "the commonest malignancy"
Ä Hepatoma, cholangioma & mixed.
Pathology:
1- At the site : the cause.
2- Above the Obst.: the same as calc. obst. but the G.B. is usually distended according to courvoisier's low Except in:
a) Cases with assosciated ch. cholecystitis.
b) Obstruction is high above the cystic duct.
3- Below the obst: The same as calc. obst. jaundice.
Clinical Picture:
· Usually progressive painless jaundice.
· If pain occurred it is dull aching pain in the epigastrium and referred to the back.
· Manifestations of underlying malignancy.
Investigations: The same as calc. obst. Jaundice.
Treatment:
1. General preoperative preparation patient with obstructive jaundice: See before.
2. Percutaeneous transhepatic drainage of bile is done for dranage as a preoperative preparation and through it a choledochoscopy and palliative stents can be inserted.
3. The surgery can be planned according to the situation:
· Operable cases of cancer head of pancreas or periampullary carcinoma treated by radical resection, see later.
· Inoperaple cases in whome stents failed to be inserted may need palliative bypass according to the site of obstruction:
· If obstruction at lower part of the common bile duct: Cholecystojejunostomy is simple operation but narrow cystic duct decrease its popularity. Choledochojejunostomy or choledocho-duodenostomy gives more wide drainage.
· If obstruction is at the level of porta hepatis, hepaticojejunostomy can be performed by cutting through the liver and anastomosing wide intrahepatic duct to a loop of jejunum.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt
1- Pancretic carcinoma
ÄCA head of pancreas. Ä Periampullary carcinoma.
2- 2ry L.N. at porta hepatis.
3- Malignancy of the liver
Ä 2ries "the commonest malignancy"
Ä Hepatoma, cholangioma & mixed.
Pathology:
1- At the site : the cause.
2- Above the Obst.: the same as calc. obst. but the G.B. is usually distended according to courvoisier's low Except in:
a) Cases with assosciated ch. cholecystitis.
b) Obstruction is high above the cystic duct.
3- Below the obst: The same as calc. obst. jaundice.
Clinical Picture:
· Usually progressive painless jaundice.
· If pain occurred it is dull aching pain in the epigastrium and referred to the back.
· Manifestations of underlying malignancy.
Investigations: The same as calc. obst. Jaundice.
Treatment:
1. General preoperative preparation patient with obstructive jaundice: See before.
2. Percutaeneous transhepatic drainage of bile is done for dranage as a preoperative preparation and through it a choledochoscopy and palliative stents can be inserted.
3. The surgery can be planned according to the situation:
· Operable cases of cancer head of pancreas or periampullary carcinoma treated by radical resection, see later.
· Inoperaple cases in whome stents failed to be inserted may need palliative bypass according to the site of obstruction:
· If obstruction at lower part of the common bile duct: Cholecystojejunostomy is simple operation but narrow cystic duct decrease its popularity. Choledochojejunostomy or choledocho-duodenostomy gives more wide drainage.
· If obstruction is at the level of porta hepatis, hepaticojejunostomy can be performed by cutting through the liver and anastomosing wide intrahepatic duct to a loop of jejunum.
SOURCE: DR. AYMAN SALEM'S BOOK
Copyright: Vascular Society of Egypt (www.vsegypt.org (http://www.vsegypt.org/)) &Medical Educational web (www.meduweb.com (http://www.meduweb.com/))
Not to be reproduced without permission of Vascular Society of Egypt