What are the clinical features of obstructive jaundice?
Features of obstructive jaundice are:
Deep yellow or mustard oil-coloured urine due to presence of conjugated bilirubin
(in liver, bilirubin is conjugated by enzyme glucuronyl transferase).
Stool is pale or clay coloured (china-clay) due to absence of bile pigment in stool.
There is presence of steatorrhoea (soft, pale, frothy, bulky, offensive and oily stool
which is difficult to flush from the toilet pan but once cleaned, it floats on the water
of the pan).
Usually deep jaundice and bulbar conjunctiva looks greenish-yellow due to oxidation
of bilirubin to biliverdin (green). Serum bilirubin is predominantly of conjugated
variety.
Severe itching or pruritus with scratch marks in skin and shiny nails. It is due to
irritation of free nerve endings by bile salts (sodium taurocholate and sodium
glycocholate), or upregulation of opoid receptors and increase level of endogenous
opioids (recent view).
Sinus bradycardia due to inhibition of SA node by bile salts.
Gall bladder may be palpable; if so, it indicates the site of obstruction in the bile
duct and is usually due to carcinoma of the head of pancreas (not due to impacted
stone in bile duct resulting from cholecystitis with choledocholithiasis as in that
situation, gall bladder will be shrunken and not palpable)—according to Courvoisier’s
law.
Xanthelasma around the eyes, and xanthoma in the knees or buttocks develop as a
result of hypercholesterolaemia due to prolonged cholestasis.
Late features—Weight loss, bleeding tendency with petechiae/purpura/ecchymosis
(vitamin K deficiency), night blindness (vitamin A deficiency), osteomalacia/bone
pain/fracture of bone (vitamin D deficiency or hepatic osteodystrophy), and muscle
cramps (vitamin E deficiency). Remember, lack of bile salts prevent absorption of
fat-soluble vitamins like A, D, E and K.
H/o intermittent fever with chill and rigor, and recurrent abdominal pain with
fluctuating jaundice may be present due to acute cholangitis (Charcot’s biliary triad).
There may be hepatosplenomegaly. Chledocholithiasis may give rise to pain
abdomen.
Features of obstructive jaundice are:
Deep yellow or mustard oil-coloured urine due to presence of conjugated bilirubin
(in liver, bilirubin is conjugated by enzyme glucuronyl transferase).
Stool is pale or clay coloured (china-clay) due to absence of bile pigment in stool.
There is presence of steatorrhoea (soft, pale, frothy, bulky, offensive and oily stool
which is difficult to flush from the toilet pan but once cleaned, it floats on the water
of the pan).
Usually deep jaundice and bulbar conjunctiva looks greenish-yellow due to oxidation
of bilirubin to biliverdin (green). Serum bilirubin is predominantly of conjugated
variety.
Severe itching or pruritus with scratch marks in skin and shiny nails. It is due to
irritation of free nerve endings by bile salts (sodium taurocholate and sodium
glycocholate), or upregulation of opoid receptors and increase level of endogenous
opioids (recent view).
Sinus bradycardia due to inhibition of SA node by bile salts.
Gall bladder may be palpable; if so, it indicates the site of obstruction in the bile
duct and is usually due to carcinoma of the head of pancreas (not due to impacted
stone in bile duct resulting from cholecystitis with choledocholithiasis as in that
situation, gall bladder will be shrunken and not palpable)—according to Courvoisier’s
law.
Xanthelasma around the eyes, and xanthoma in the knees or buttocks develop as a
result of hypercholesterolaemia due to prolonged cholestasis.
Late features—Weight loss, bleeding tendency with petechiae/purpura/ecchymosis
(vitamin K deficiency), night blindness (vitamin A deficiency), osteomalacia/bone
pain/fracture of bone (vitamin D deficiency or hepatic osteodystrophy), and muscle
cramps (vitamin E deficiency). Remember, lack of bile salts prevent absorption of
fat-soluble vitamins like A, D, E and K.
H/o intermittent fever with chill and rigor, and recurrent abdominal pain with
fluctuating jaundice may be present due to acute cholangitis (Charcot’s biliary triad).
There may be hepatosplenomegaly. Chledocholithiasis may give rise to pain
abdomen.