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Part 3: The surgeon's perspective

The first two of these three articles have looked at the issues of management of extrahepatic biliary tract obstruction from diagnostic and therapeutic view points. By the time the case has been transferred to the surgical team, the patient may still be in a critical condition. Extra hepatic biliary duct obstruction (EHBDO) has a number of systemic physiologic effects, other than the obvious clinical sign of jaundice (Figure 1). Patients may be inappetant, and in a cachectic condition, they may have an anaemia of chronic disease, intestinal sloughing or haemorrhage, hepatic compromise, coagulopathy, endotoxaemia, decreased myocardial contractility, acute tubular necrosis and be at risk of biliary tract rupture.

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Figure 1. Clinical signs of jaundice

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