A type of jaundice that is caused by an obstruction to the passage of bile.

The most common cause of obstructive jaundice would be a gallstone impacting in the common bile duct. The clinical picture of this would be of increasing jaundice and abdominal pain over several days, followed by waxing and waning of the pain and jaundice over a background level as the stone dis-impacts and re-impacts in the common bile duct.

The next most common cause of obstructive jaundice would be cancer in the head of the pancreas which had squeezed the common bile duct shut as it passed through the head of the pancreas. The clinical picture for this would be increasing jaundice over several weeks, with unremitting symptoms. Darkening of the urine may be noticed for several weeks preceding any obvious skin yellowing. Anorexia, weight loss and malaise may accompany the cancer. Abdominal pain may be absent until late in the disease.

Less common causes would include cancer of the bile duct itself, strictures causing compression of the bile duct (often from previous surgery), masses (such as metastatic cancer) in the porta hepatis and Mirizzi's syndrome.

An important consideration in obstructive jaundice is relieving the symptoms. This may involve placing a stent in the bile duct via an endoscopic procedure (ERCP) to achieve drainage.

Useful investigations are done with ultrasounds, to visualize gallstones and to detect dilatation of the biliary tree, CT scans to detect masses in the porta hepatis and in the pancreas, and ERCP as either a diagnostic or palliative tool.

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