Jaundice

Surgery

Assumptions

Student understands the mechanisms for production, excretion, and metabolism of bile and can recall the anatomy of the hepatobiliary system.

Knowledge Objectives

Through their reading and patient care experiences, at the end of the rotation students should be able to:

Describe the differential diagnosis of a patient with jaundice
Discuss, prehepatic, intrahepatic (both non-obstructive) and posthepatic (obstructive) etiologies.
Discuss painful vs. non-painful
Discuss benign vs. malignant
Discuss inflammatory vs. non-inflammatory
List & explain justification for the diagnostic modalities used in the evaluation of a patient with jaundice, to include limitations, relative costs and potential risks.
Discuss importance of the patient's history: estimated duration of illness, associated symptoms (pain and its characteristics), and risk factors including alcohol abuse, and hepatitis vaccination history.
Discuss important physical exam findings:
hepatomegaly
palpable mass
Courvoisier's sign
Murphy's sign
scleral icterus
abdominal tenderness
lymphadenopathy
Charcot's triad
Reynold's pentad
Explain the rationale for using these diagnostic tests in the evaluation of a patient with jaundice. What is the significance of abnormalities?
liver function tests
other laboratory tests and their indications (including hepatitis profile, peripheral blood smear, Coombs tests, etc.)
hepatobiliary imaging procedures (ultrasound, CT scan, ERCP, PTHC, HIDA scan).
Discuss the management principles (to include initial treatment; role and timing of surgery; and, if necessary, timing of appropriate consultation) of:
cholecystitis
choledocholithiasis
cholangitis
cholangiocarcinoma
hepatic abscess
pancreatic CA
periampullary CA
hepatic CA
autoimmune hemolysis
hepatitis
hematobilia
periampullary duodenal diverticulum
Discuss importance of appropriate transfusion practices.