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Obstructive jaundice is a type of conjugated hyperbilirubinemia caused by impaired bile flow from the liver to the duodenum due to mechanical obstruction in the extrahepatic or intrahepatic biliary tree.

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Etiopathology

Obstruction level	Etiology
Intraluminal	• ‣ (commonest cause)
• Parasites (Clonorchis, Ascaris, Fasciola)
Mural (biliary wall)	• ‣ (hilar/Klatskin, distal)
• Benign biliary strictures (iatrogenic post-cholecystectomy, chronic pancreatitis)
Extraluminal (External compression)	• ‣
• ‣
• Pancreatitis / pseudocyst
• Lymphadenopathy at porta hepatis
• ‣ (impacted cystic duct stone compressing CBD)

Pathophysiology:

Bile outflow obstruction → increased intra-biliary pressure → regurgitation of conjugated bilirubin into blood → jaundice.
Bile salt deficiency in gut → fat malabsorption → steatorrhea, fat-soluble vitamin deficiency (A, D, E, K).

Clinical Features

Jaundice (progressive, deepening)
Pruritus (due to bile salts in skin)
Clay-colored stools, dark urine
Right upper quadrant pain: colicky in stones, dull in malignancy
Weight loss, anorexia (malignancy)
Fever with chills (Charcot’s triad): when complicated by cholangitis

Laboratory Findings

Cholestatic pattern of LFTs:
- ↑ Conjugated bilirubin
- ↑ Alkaline phosphatase (ALP), ↑ γ-GT
- Mild ↑ transaminases (AST, ALT)
Prolonged PT/INR (due to Vit K malabsorption)

Radiology