Jaundice

Jaundice is a complication resulting from a blockage in your bile duct. Your skin and the whites of your eyes appear to be slightly yellow.

Treating jaundice
If it is not possible to remove the tumour that is causing the blockage in your bile duct, your doctor may be able to use a stent to relieve the blockage so that the bile can flow into your small bowel again.

Using a stent to treat a blocked bile duct
A stent is a tube made of either plastic or an expanding metal mesh. During an ERCP (Endoscopic Retrograde Cholangio-Pancreatography) or PTC (Percutaneous Transhepatic Choloangiogram) the stent is pushed down the inside of the blocked duct to hold it open. The ERCP method is used more often.

Percutaneous Transhepatic Cholangiogram (PTC)
The PTC method is similar to an ERCP, in that a dye is used to show up the obstruction on an X-ray. Instead of the tube being inserted through an endoscope, a needle is inserted through your skin just below your rib cage and a fine guide-wire is passed through your liver and into the blockage in the bile duct. The stent is then passed along this wire.

What happens during a PTC?
As with ERCP, you must not eat or drink anything for at least six hours beforehand. You will have some sedation and you will also have a local anaesthetic, so you should not feel pain as the needle or wire is passed through the skin. Some people find that moving the wire into the correct position in the bile duct can be quite painful. To prevent any infection, a doctor will give you antibiotics before and after the procedure.

After your PTC you will need to lie flat in bed for six hours. It is likely you will stay in hospital for a few days afterwards until everything settles down.

What happens if the stent becomes blocked?

Signs that indicate that the stent could be blocked are:

  • you become jaundiced again;
  • you may feel hot and cold with episodes of severe shivering – these episodes are known as “rigors”;
  • your urine becomes dark; and
  • your bowel motions become pale.

Please always remember that if you think your stent is blocked it is very important that you contact your general practitioner, hospital doctor or specialist nurse immediately. Make sure you have their phone numbers handy.

Eating and drinking when you are jaundiced

Jaundice can affect your appetite and sense of taste. The following hints may be useful:

  • Small, frequent meals are often tolerated better earlier in the day.
  • Often you may find you have more energy and appetite for eating earlier in the day, and small portions can be more comfortable.
  • Try to drink plenty of fluids, particularly nutritious fluids such as milk.
  • It is important to keep well hydrated and by using nutritious fluids, your energy levels are better.
  • Try sandwiches or cold food. It may help to get someone else to cook meals.Strong-smelling food may be off-putting.
  • Try to avoid foods that are very fatty or greasy such as fried foods.
  • Fatty or greasy food may not be digested very well.
  • Try to include snacks such as yogurt, or nutritious fluids such as milky drinks in between meals.
  • You may not manage to eat a full meal and snacks can help to provide extra energy and nutrition.

The Dietitian may provide advice or supplementary information on managing a poor appetite.

Pruritis (Itching)

What is pruritis?
Pruritis is itching of the skin when you are jaundiced. The itch is caused by a build-up of bile salts in the blood when the bile ducts are blocked or the liver is not working properly. This can also make the skin feel hot and uncomfortable.

How can the itch be treated?
The most effective way to relieve the symptoms of pruritis is to treat the underlying cause of the jaundice.

Jaundice caused by a tumour blocking the tubes that drain bile from the liver and gall bladder into the bowel (obstructive jaundice) can be treated in several ways:

  • insertion of a plastic or metal stent in the bile duct;
  • surgery to remove the tumour; or
  • surgical bypass of the blockage.

Other ways of relieving pruritis while these treatments take effect may include:

  • using an antihistamine medication;
  • a medicine called Choleystiramine – this may help the body excrete excess bile salts;
  • frequent skin care;
  • keeping skin cool and moist; and
  • using an aqueous (moisturising) skin cream, applied liberally to the affected areas to keep skin moist.