Jaundice, the yellow discolouration of the skin and whites of the eyes caused by elevated bilirubin in the blood, is not always a surgical emergency, but it always requires urgent medical evaluation to establish its cause, because some of the conditions that produce jaundice are surgical emergencies and others are not. The most important clinical distinction is between medical jaundice and obstructive jaundice. Medical jaundice, from hepatitis, liver disease, or haemolysis, reflects a problem in the liver's ability to process bilirubin rather than a blockage in the outflow pathway, and is managed medically. Obstructive jaundice, from a blockage of the common bile duct by a gallstone, a pancreatic tumour, a bile duct tumour, or a stricture, produces the distinctive pattern of progressively deepening yellow discolouration with pale or clay-coloured stools and very dark urine. The pale stools reflect the absence of bile reaching the intestine; the dark urine reflects bilirubin being excreted by the kidneys instead. Obstructive jaundice becomes a surgical or endoscopic emergency when it is complicated by cholangitis, the bacterial infection of the obstructed biliary system, which produces the classical Charcot's triad of jaundice, fever with rigors, and right upper abdominal pain. Cholangitis can progress to septic shock and multi-organ failure within hours without prompt biliary drainage, usually by ERCP. If you have jaundice accompanied by fever, shaking chills, and abdominal pain, go directly to the emergency department without delay, as this combination requires same-day biliary assessment and treatment.
Related reading:
Gallbladder, Liver, and Pancreas Surgery: When You Need a Hepatobiliary Specialist
Advanced Laparoscopic Gastrointestinal Surgery: A Complete Guide to Minimally Invasive GI Surgery
Get to Know Your Doctor: Dr. Lokesh H. M, Trusted Surgical Gastroenterologist and Advanced Laparoscopic Surgeon in Mysuru
Written by Dr. Lokesh H M, MBBS, MS, MCh Surgical Gastroenterology, Fellowship Pancreato-Biliary Surgery (SGPGIMS Lucknow), FMAS, Senior Consultant Surgical Gastroenterologist, Narayana Multispeciality Hospital and RK Speciality Clinic, Mysuru. Phone: +91 89719 08095.
