LONG-TERM MECHANICAL JAUNDICE: FROM BILIARY OBSTRUCTION TO MULTIPLE ORGAN DYSFUNCTION
Abstract
Resume. Long-term mechanical jaundice, also known as prolonged obstructive jaundice, is a severe clinical syndrome caused by persistent impairment of bile flow from the liver into the duodenum. Although it begins as a local biliary obstruction, prolonged cholestasis can lead to systemic pathological changes involving the liver, kidneys, coagulation system, immune response, gastrointestinal barrier, cardiovascular system, and metabolism. The most common benign cause is choledocholithiasis, while malignant causes include pancreatic head cancer, cholangiocarcinoma, gallbladder cancer, and ampullary carcinoma. Recent concepts describe long-term mechanical jaundice as a systemic cholestatic-endotoxic syndrome, in which biliary hypertension, accumulation of bile acids, oxidative stress, endotoxemia, bacterial translocation, systemic inflammation, coagulopathy, and renal dysfunction contribute to multiple organ dysfunction. Modern management requires early diagnosis, accurate determination of the obstruction level, severity assessment, biliary decompression, infection control, correction of metabolic and coagulation disorders, and definitive treatment of the underlying cause. Keywords: long-term mechanical jaundice, obstructive jaundice, cholestasis, choledocholithiasis, biliary decompression, endotoxemia, multiple organ dysfunction, cholangitis, ERCP.