Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-Sun 11_Varadarajulu_Imaging a patient of obstructive jaundice

Sun 11_Varadarajulu_Imaging a patient of obstructive jaundice

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The document, written by Dr. Shyam Varadarajulu of the Orlando Health Digestive Health Institute, outlines critical priorities and diagnostic considerations when managing patients with obstructive jaundice. The key priorities include distinguishing between benign and malignant causes, assessing resectability if malignant, and determining the most effective way to decompress or palliate jaundice.<br /><br />Obstructive jaundice can arise from a variety of malignant and benign sources. Malignant causes include primary carcinomas such as pancreatic, ampullary, biliary, hepatocellular, and metastatic tumors, while benign causes may be due to gallstones, Mirizzi syndrome, PSC, and other conditions.<br /><br />The document highlights the use of computed tomography (CT), MRCP (Magnetic Resonance Cholangiopancreatography), and EUS (Endoscopic Ultrasound) for diagnostics. MRCP and EUS are considered superior to CT, and EUS is particularly useful given its higher negative predictive value, though it can be performed concurrently with ERCP (Endoscopic Retrograde Cholangiopancreatography).<br /><br />In discussing diagnostic challenges such as hilar strictures and distal cholangiocarcinoma, the study emphasizes the role of EUS-guided fine needle biopsy (FNB) and single-operator cholangioscopy (SOC). These tools are vital for accurate diagnostics, especially when dealing with indeterminate biliary strictures, advanced cancers, and patients who are non-transplant candidates.<br /><br />Overall, the management of obstructive jaundice requires a multidisciplinary approach using radiological and endoscopic techniques. Collaboration with specialties like interventional radiology is crucial to ensure optimal diagnostic and therapeutic outcomes. Determining the correct diagnosis and treatment strategy is vital to patient management, with careful consideration of multimodality work-ups for comprehensive evaluation.

Keywords

obstructive jaundice

diagnostic considerations

benign causes

malignant causes

EUS

MRCP

fine needle biopsy

cholangioscopy

multidisciplinary approach