At the diagnostic stage, the surgeon needs to get answers to a number of critical questions that directly determine the treatment tactics.
Questions and answers in the diagnosis and treatment of obstructive jaundice
- Does the patient have obstructive jaundice?
Jaundice can occur not only in violation of the separation of bile, but also in other diseases, particularly viral hepatitis, when the liver parenchyma suffers. This is important to know, since the treatment tactics directly depends on the establishment of the cause. In viral hepatitis, antiviral therapy is used, for example, with sofosbuvir (India Help is a company that can deliver a generic sofosbuvir to the Russian Federation). And when establishing the fact of biliary obstruction, further surgical tactics depend on the severity of obstructive jaundice.
- What is the severity of obstructive jaundice?
In the case of mild obstructive jaundice, biliary decompression is usually not required. With moderate and severe degrees – it is a top priority.
- Does the patient have cholangitis?
If there is one, the time for making a decision on the method of biliary decompression should be shortened as much as possible, since the urgent resolution of biliary obstruction serves to prevent the development of cholangiogenic sepsis and abscess formation of the liver.
- Are there any contraindications to the drainage of the biliary tract?
General contraindications include hypocoagulation, which must be corrected before invasive procedures begin.
- What decompression method is required for this patient?
The endoscopic method of retrograde biliary tract decompression is more “physiological”, since it is not accompanied by external loss of bile. It serves as a method of choice in low biliary tract block – choledocholithiasis, periampular tumors, stenosis of the major duodenal papilla. Limit the use of the method: the duodenum off the passage of food (after stomach resection of Billroth II), stenosis of the esophagus, stomach and the initial parts of the duodenum, parapapillary diverticulum, previously formed terminolateral hepaticojejunostomy.
Percutaneous antegrade decompression is the method of choice for a high block of bile-excretion: portal cholangiocarcinoma, metastasis of cancer and lymphoma in the hepatoduodenal ligament, stenosis, hepaticojejunostomy