People with jaundice have a yellow color in the white part of their eyes and a yellowish skin color. This comes from having high levels of bilirubin in the bloodstream. In obstructive jaundice, there are high bilirubin levels because the bile flow is blocked, and bilirubin is one component of bile.
Obstructive Jaundice
Red blood cells live for 120 days, then the cells disintegrate and some of their parts are recycled. Some of the hemoglobin is changed to bilirubin, attached to a protein and sent to the liver where the bilirubin is changed and becomes part of bile. In obstructive jaundice, the flow of bile is blocked and the bilirubin is absorbed into the bloodstream. The high levels of bilirubin in the bloodstream cause jaundice.
The Blockage of Bile
Bile leaves the liver through structures called the right and left hepatic ducts. These two hepatic ducts join to form a common hepatic duct, and this duct then leads to a common bile duct. Obstructive jaundice can happen if the flow of bile is blocked in the bile ducts within the liver or blocked in the common bile duct. Gallstones in the common bile duct are a very common cause of obstructive jaundice, according to Kim Barrett, Ph.D., Vice-Chair for Research at the University of California School of Medicine in "Gastrointestinal Physiology."
Statistics
Approximately 10 to 15 percent of the people with gallstones have them in the common bile duct, reports Dr. Greenberger in "Harrison's Principles of Internal Medicine." More elderly people have gallstones in the common bile duct, for it is estimated that 25 percent of them have stones in this duct. Most gallstones are formed within the gallbladder, but many leave the gallbladder and migrate to the common bile duct. From there, the stones may continue on to the small intestines or stay in the common bile duct and obstruct the bile flow.
Evaluation
An ultrasound is the first procedure done to see if gallstones are causing the obstructive jaundice. Most gallstones will not show up on an X-ray because of their structure, but the radiologist can see the gallstones on an ultrasound. In addition, it is safe to use an ultrasound on a pregnant woman. The physician can then decide whether other tests are necessary.
Treatment
An ERCP is done to remove the gallstones causing jaundice. ERCP is short for endoscopic retrograde cholangiopancreatography, a procedure that uses a thin tube with a camera on the end so the surgeon can see the common bile duct. The surgeon will then use the ERCP to make the opening of the duct larger so the gallstones can safely pass through.
References
- "Gastrointestinal Physiology"; Kim Barrett, Ph.D.; 2006
- "Harrison's Principles of Internal Medicine"; Anthony Fauci, M.D., Dennis Kasper, M.D., Dan Longo, M.D. et al.; 2008
- The Merck Manual for Healthcare Professionals: Choledocholithiasis and Cholangitis
