APPROACH TO DIAGNOSIS AND MANAGEMENT OF JAUNDICE
AND HEPATO BILIER DISORDERS
CHAPTER I
INTRODUCTION
Jaundice is a change of skin color, eye sclera or other tissues (mucous membranes), which became yellow due to staining by an increased concentration of bilirubin in the blood circulation. Bilirubin (Bile) is formed as a result of solving hem ring, usually as a result of red blood cell metabolism.
The word jaundice (jaundice) derived from the French word meaning yellow Jaune. Jaundice should be examined under a bright light during the day, by looking at the eye sclera. Jaundice can be divided into two groups: Hemo ¬ lytic jaundice and obstructive jaundice.
Obstructive jaundice, caused by bile duct obstruction (¬ ter so often when a gallstone or cancer of the duct cover koledokus) or liver cell damage (which was finished in hepatitis ¬), speed of formation of bile is normal, but the bilirubin formed does not get through from the blood into the intestine.
Obstructive jaundice, also called cholestasis were divided into 2 of intrahepatic cholestasis and extrahepatic. The most common cause is intrahepatic cholestatic hepatitis, drug toxicity, alcoholic liver disease due to hepatitis and autoimmune diseases, while the most frequent cause of extrahepatic cholestasis is koledokus duct stones and pancreatic cancer. Other causes are relatively rare benign stricture (previous surgery) on koledokus duct, ductal carcinoma koledokus, pancreatitis or pancreatic pseudocyst and sklerosing cholangitis.
Extra-hepatic biliary obstruction usually require surgery, extraction of gallstones diduktus, or stent insertion, via catheter for drainage and stricture (often malignant) or narrowing of the majority. For non-malignant obstruction operabel, palliative biliary drainage can be done through the stent is placed through the liver (transhepatic) or endoscopic.
Generally, non-obstructive jaundice does not require surgical intervention, whereas obstructive jaundice usually requires surgical intervention or other interventional procedures for treatment.
CHAPTER II
JAUNDICE
DEFINITION II.1 JAUNDICE
Jaundice (derived from French 'Jaune' meaning yellow) or jaundice (Latin for jaundice) is a yellow coloring of the skin, sclera, and mucous membranes by the deposit of bilirubin (bile pigment yellow-orange) on the network. Jaundice is a condition in which tissue yellowish due to deposition of bilirubin occurs when blood levels of bilirubin reaches 2 mg / dL or 35-40 mmol / L.
II.2 SYSTEM ANATOMY HEPATOBILIER
An accurate knowledge of the anatomy of the liver and biliary tract, and its relationship to blood vessels critical to the performance of surgery hepatobilier because there is usually a wide anatomic variations. Classical anatomical description of the biliary tract occurs only in 58% of the population.
Liver, gallbladder, and biliary branches arise from the ventral bud (hepatic diverticulum) from the most caudal foregut early in the fourth week of life. This section is divided into two sections as part of the ventral mesenterik grow between layers: a larger cranial part (pars hepatic) is the origin of the heart / liver, and a smaller caudal part (pars sistika) extended form of the gallbladder, the stem into the cystic duct. Initial relationship between the hepatic diverticulum, and narrowing of the foregut, will form the common bile duct. As a result of changes in the position of the duodenum, bile duct entrance is located around the dorsal aspect of the duodenum.
Biliary system is broadly divided into two components, pathways of hepatic intra-and extra-hepatic. Unit secretion of the liver (hepatocytes and biliary epithelial cells, including gland peribilier), kanalikuli bile, bile duktulus (Hearing canal), and intrahepatic bile duct intrahepatic form a channel in which the extrahepatic bile ducts (right and left), the communist hepatikus duct, cystic duct, bladder bile, and the common bile duct is a component of extrahepatic biliary branching.
Ekstrahepatal bile duct consists of left and right hepatikus duct, common hepatic duct, cystic duct and common bile duct or hepatic duct koledokus.Duktus right and left out of the heart and joined the Communist hepatic hilum to form ducts, usually the anterior bifurcation of the portal vein and the Cosmos proximal hepatic artery close to the right. Duct extrahepatic part of the left tend to be longer. Duct hepatikus communists built left border of Calot triangle and continues with duct koledokus. Division occurs at the level of the cystic duct. Koledokus duct about 8 cm in length and lies between the ligamentum hepatoduodenalis, to the right of the hepatic artery and anterior to the portal vein. Koledokus distal segment of the duct located within the substance of the pancreas. Koledokus duct empties its contents into the duodenum through the ampulla of Vater, surrounded by a muscular orifisiumnya of sphincter of Oddi. Typically, there are common channels of the pancreatic duct and the duct distal koledokus.
The blood supply to the gall bladder is through the arteries sistika; to be divided into anterior and posterior, typically a branch of the right hepatic artery, but the origin of the artery sistika vary. Sistika arteries arise from the Calot triangle (formed by the cystic duct, common hepatic duct and the tip of the liver). Venous drainage of the gallbladder varies, usually into the right branch of portal vein. Lymph flow directly entered into the heart and also to the lymph-nodes along the surface of the portal vein .. Persarafannya derived from the vagus and sympathetic branches of the celiac plexus passes (preganglionic T8-9). Impulses from the liver, gallbladder, and bile ducts melewari through sympathetic afferent nerve and causing pain splanknik colic. Nerves arise from the celiac axis and located along the hepatic artery. Pain sensation is mediated by visceral fibers, sympathetic. Motor stimulus for gallbladder contraction is carried through the branches of the vagus and the celiac ganglion.
