Ictericia obstructiva

Abstract

Obstructive jaundice is a clinical condition characterized by yellow discoloration of the skin and mucous membranes due to increased plasma bilirubin, usually caused by post-hepatic biliary obstruction. This condition can lead to severe complications such as acute cholangitis, considered a surgical emergency. Biliary obstruction increases pressure in the ducts, impairs liver function, and produces systemic effects: hepatocyte toxicity, altered drug metabolism, increased infection risk, coagulopathy, and renal dysfunction.

Causes may be benign (choledocholithiasis, biliary stricture, sclerosing cholangitis, parasitosis) or malignant (gallbladder cancer, pancreatic cancer, cholangiocarcinoma). Diagnosis is based on clinical findings (jaundice, dark urine, pale stools, pruritus), laboratory tests (direct hyperbilirubinemia, elevated alkaline phosphatase and gamma-glutamyl transferase), and imaging (initial ultrasound, magnetic resonance cholangiopancreatography, computed tomography, magnetic resonance imaging). The presence of fever, hypotension, and altered mental status suggests acute cholangitis.

Treatment depends on the cause and patient condition. In cholangitis, stabilization and urgent biliary drainage (endoscopic retrograde cholangiopancreatography, percutaneous drainage, or surgery) are required. For benign obstructions, endoscopic management is preferred; for malignant cases, resectability or palliative drainage is assessed. A multidisciplinary approach is essential to optimize diagnosis and treatment.