What are the causes of obstructive jaundice?

Causes of obstructive jaundice:

Intra-luminal causes of jaundice:

• Stone in common Bile Duct (CBD)
• Roundworm
• Broken T-tube
• Dislodged dormio basket
• Rarely blood clot (postoperatively)

Intra-mural causes of jaundice:

• Sclerosing cholangitis
• Cholangiocarcinoma
• Stricture (maybe following surgery, trauma).

Extra-luminal causes of jaundice:

• Carcinoma of the head of the pancreas
• Periampullary carcinoma
• Lymphoma
• Enlarged LN of porta hepatis
• Rarely primary duodenal cancer or prolonged peptic ulcer in posterior of stomach or duodenum

Common causes of obstructive jaundice (for viva):

• Stone in CBD
• Carcinoma of the head of the pancreas
• Malignancy of CBD ( Cholangiocarcinoma)
• Periampullary carcinoma
• Worm in CBD

Causes of obstructive jaundice in children:

• Congenital biliary atresia
• Choledochal cyst
• Thick bile

Additional:

The pattern of jaundice:

• In Ca of the head of the pancreas: Painless progressive jaundice
• In stone of CBD: Intermittent jaundice
• Periampullary carcinoma / Cholangiocarcinoma: Fluctuating jaundice

Courvoisier's law:

There is a law about the palpable gallbladder. It is called Courvoisier's law.

Palpable gall bladder with jaundice is never due to stone in CBD, rather it is due to pressure on the CBD from outside, e.g. Carcinoma of the head of the pancreas.

Source:

• Long cases in Clinical Medicine by Dr ABM Abdullah