Obstructive Jaundice

What is Obstructive Jaundice?

Jaundice is a yellow color of the skin, mucus membranes, or eyes. The yellow coloring comes from bilirubin, a byproduct of old red blood cells. Obstructive jaundice is a specific type of jaundice, where symptoms develop due to a narrowed or blocked bile duct or pancreatic duct, preventing the normal drainage of bile from the bloodstream into the intestines.

Specialists at the Center for Advanced Digestive Care (CADC) at NewYork-Presbyterian/Weill Cornell Medical Center are experienced in diagnosing and treating the causes of obstructive jaundice. Our Center for Liver Disease and Transplantation uses a multidisciplinary approach and tailor treatment to the needs of each patient.

Types of Obstructive Jaundice

Jaundice, the yellowing of the skin, mucus membranes, or eyes, can come in different forms. Some common types of jaundice include:

• Hepatocellular Jaundice: This type of jaundice occurs when there is damage or dysfunction in the liver cells (hepatocytes). Conditions such as hepatitis, cirrhosis, or liver cancer can lead to hepatocellular jaundice. Elevated bilirubin levels occur due to the liver's inability to metabolize or excrete it into bile properly.
• Haemolytic Jaundice: Haemolytic jaundice results from an increased breakdown of red blood cells, leading to elevated levels of unconjugated bilirubin in the bloodstream. Conditions such as hemolytic anemia, certain genetic disorders like sickle cell disease, or autoimmune reactions can cause hemolytic jaundice. The liver becomes overwhelmed by the excessive bilirubin production, accumulating in the blood and tissues, causing the characteristic yellowing of the skin and eyes associated with jaundice.

Symptoms of Obstructive Jaundice

Obstructive jaundice, also known as cholestatic jaundice, is a condition characterized by the obstruction of bile flow from the liver to the small intestine. This obstruction can occur due to various reasons, such as gallstones, tumors, or inflammation of the bile ducts. Recognizing the symptoms of obstructive jaundice is crucial for timely diagnosis and treatment. Here are some common symptoms associated with this condition:

• Yellowing of the skin and eyes (jaundice): One of the hallmark symptoms of obstructive jaundice is the yellow discoloration of the skin and the whites of the eyes. This occurs due to the buildup of bilirubin, a yellow pigment, in the bloodstream when the liver cannot properly process and excrete it.
• Dark urine: Obstructive jaundice can cause urine to become dark in color. This darkening occurs because excess bilirubin is excreted through the kidneys and urine.
• Pale stools: Unlike dark urine, stools may become pale or clay-colored. This change in stool color occurs because bile, which gives stool its characteristic brown color, is not properly reaching the intestine due to the obstruction.
• Itchy skin (pruritus): Many individuals with obstructive jaundice experience itching of the skin, known as pruritus. This itching can range from mild to severe and is thought to be caused by the accumulation of bile salts in the bloodstream. 
• Abdominal pain: Depending on the underlying cause of the obstruction, individuals may experience abdominal pain, particularly in the upper right quadrant of the abdomen. This pain can vary in intensity and may be accompanied by other symptoms such as nausea and vomiting.
• Fatigue and weakness: Obstructive jaundice can lead to fatigue and weakness due to impaired liver function and the buildup of toxins in the bloodstream.
• Loss of appetite and weight loss: Some individuals with obstructive jaundice may experience a loss of appetite, leading to unintentional weight loss. 

It's important to note that the severity and combination of symptoms can vary depending on the underlying cause of the obstruction and individual factors. If you or someone you know is experiencing any of these symptoms, especially jaundice, seeking medical attention promptly for proper diagnosis and management is essential. Early detection and treatment can help prevent complications and improve outcomes for individuals with obstructive jaundice. 

Please ensure to consult with a healthcare professional for accurate diagnosis and treatment if you suspect any medical conditions.

• Hepatocellular Jaundice: This type of jaundice occurs when there is damage or dysfunction in the liver cells (hepatocytes). Conditions such as hepatitis, cirrhosis, or liver cancer can lead to hepatocellular jaundice. Elevated bilirubin levels occur due to the liver's inability to metabolize or excrete it into bile properly.
• Haemolytic Jaundice: Haemolytic jaundice results from an increased breakdown of red blood cells, leading to elevated levels of unconjugated bilirubin in the bloodstream. Conditions such as hemolytic anemia, certain genetic disorders like sickle cell disease, or autoimmune reactions can cause hemolytic jaundice. The liver becomes overwhelmed by the excessive bilirubin production, accumulating in the blood and tissues, causing the characteristic yellowing of the skin and eyes associated with jaundice.

What Causes Obstructive Jaundice?

Obstructive jaundice may be due to a number of causes, all of which narrow or block the bile ducts in some way:

• Gallstones
• Pancreatic cancer, when it occurs near the tube connecting the pancreas to the intestines
• Swelling of lymph glands near the bile duct
• Pancreatic cysts
• Other pancreatic duct obstructions such as scarring

How is Obstructive Jaundice Diagnosed?

Because obstructive jaundice has high mortality rates, early detection, diagnosis and treatment is essential. The following tests may be performed by our specialists to diagnose the cause of obstructive jaundice:

• Imaging tests such as CT scanning and magnetic resonance imaging
• Blood tests to examine bilirubin levels
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound (EUS)
• Choledochoscopy
• Probe-based confocal endomicroscopy
• Narrow band imaging of the bile duct

Treatment of Obstructive Jaundice

The treatment of obstructive jaundice depends on its cause. Clogged or narrowed bile or pancreatic ducts may be relieved by inserting a stent using ERCP. The CADC's interventional endoscopy specialists are experts in performing ERCP, EUS, EUS-guided ERCP, and other EUS-guided procedures.

Bile duct cancer can be treated with photodynamic therapy (PDT) or radiofrequency ablation (RFA) before placing a stent, while pancreatic cancer can be treated by RFA and stenting. Cancers causing obstruction may require more extensive surgery by the CADC's hepatobiliary surgical team. Some patients receive chemotherapy and/or radiation therapy in combination with their surgical or endoscopic procedure.

At the CADC and the Center for Liver Disease and Transplantation, specialists in gastroenterology, hepatology, endoscopy, radiology, and surgery work together as an interdisciplinary team to provide each patient with coordinated, advanced, and individualized care.

Receive Care for Obstructive Jaundice at NewYork-Presbyterian

If you suspect you or a loved one is experiencing jaundice, don't hesitate to reach out to the experts at NewYork-Presbyterian for help. Call to book an appointment with one of our team members.