Cholestatic jaundice- treatment options?
Hello, my neighbor is a 45-year-old male with no past medical history was suffering from generalized abdominal pain, jaundice, dark urine, and lower extremity edema from one week. His initial evaluation revealed severe hyperbilirubinemia and elevated transaminases. He denied any alcohol consumption for the previous twenty years or intravenous drug use. He had no medical history, was taking no medications prior to presentation, except a multivitamin. He denied taking any herbal supplements and his family history was unremarkable. He was married and employed as an auto mechanic. He has been diagnosed with cholestatic jaundice. Please let me know the treatment options.
@mainak Management of cholestatic jaundice widely depends upon underlying etiology and type of cholestasis. Usually, the mainstay of obstructive cholestasis is biliary decompression. Management of hepatocellular cholestasis includes symptomatic treatment of associated symptoms while specific treatment for the underlying disease process is attempted. In common bile duct stones, endoscopic sphincterotomy with or without stent placement can relieve the obstruction. Similarly, in benign CBD strictures, stricture dilation and stent placement can relieve the obstruction.
In malignant obstruction, depending upon the stage of disease and the operative candidacy of the patient, surgical resection of the obstructive lesion is preferred. If complete resection is not possible, surgical hepaticojejunostomy and the Roux-en-Y bypass is an option. If a patient is not a surgical candidate, either palliative CBD stent is placed endoscopically (usually metal stent). If endoscopic stent placement is not successful, a percutaneous transhepatic cholangiography tube can be placed for biliary decompression. Antibiotics are considered in pre and post biliary decompression phase to reduce the risk of sepsis.