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Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1262-1276
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1262
Pathophysiological consequences and treatment strategy of obstructive jaundice
Jun-Jian Liu, Yi-Meng Sun, Yan Xu, Han-Wei Mei, Wu Guo, Zhong-Lian Li
Jun-Jian Liu, Zhong-Lian Li, Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, Tianjin 300102, China
Yi-Meng Sun, Yan Xu, Wu Guo, Graduate School, Tianjin Medical University, Tianjin 300070, China
Han-Wei Mei, Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
Author contributions: Li ZL and Liu JJ wrote and edited the manuscript; Sun YM and Mei HW made the Figure of the manuscript; Xu Y and Guo W edited and formatted the manuscript; all authors have read and approved the final manuscript.
Supported by Tianjin Municipal Education Commission Scientific Research Program, China, No. 2022KJ271.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong-Lian Li, Doctor, MD, PhD, Professor, Department of Hepatobiliary and Pancreatic Surgery, Tianjin Medical University Nankai Hospital, No. 6 Changjiang Road, Tianjin 300102, China. nkyylzl@163.com
Received: March 20, 2023
Peer-review started: March 20, 2023
First decision: April 21, 2023
Revised: April 29, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: July 27, 2023
Processing time: 123 Days and 11 Hours
Abstract

Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.

Keywords: Jaundice; Obstructive; Pathophysiology; Treatment strategy; Traditional Chinese medicine

Core Tip: Obstructive jaundice is a complex condition with systemic effects, and its management requires a multidisciplinary approach. Adequate supportive measures and identification of the cause, location, and severity of obstruction are crucial for effective treatment. Surgical and endoscopic interventions, as well as medical treatment, can be valuable options, depending on the patient's condition. Therefore, a thorough understanding of the pathophysiology and a comprehensive approach to management are necessary for better outcomes.