REASONS FOR JAUNDICE IN GALL STONE DISEASE

First and common reason for jaundice in gall stone disease is due to the migration of gall stone from gall bladder in to the common bile duct which leads to blockage of bile duct and ends up with development of jaundice.

This jaundice is usually associated with pain abdomen and fever with rigor in case of associated infection. So, pain abdomen with fever and jaundice suggests the possibility of bile duct obstruction due to gall stone.

In case of jaundice due to common bile duct (CBD) obstruction there will be a fluctuating jaundice associated with pain abdomen. This fluctuation is because of impaction of stone at the lower end of bile duct leads to blockage of bile flow and increase in serum bilirubin level. Once the block is tight that leads to dilatation of proximal bile duct which dis-impacts the stone from below which allows the bile to flow in to the duodenum. This mechanism leads to decrease in serum bilirubin level and so fluctuating jaundice.

Second reason for jaundice in gall stone disease is due to associated haemolytic jaundice. Haemolytic jaundice means excessive destruction of red blood corpuscles than normal. This condition is common in young age group and age is not a criterion to make a diagnosis of haemolytic jaundice. Congenital spherocytosis and sickle cell anaemia are classical examples of haemolytic anaemia.

Third important reason for jaundice in gall stone disease is due to severe infection and inflammation of gall bladder with severe damage to gall bladder mucosa. This severe mucosal damage (Gangrenous) leads to damage to the mucosal barrier of the gall bladder and so absorption of bile from the gall bladder into the blood stream. This leads to the development of jaundice. This jaundice is mild but with features of severe gall bladder infection.

Other reasons for jaundice in gall stone diseases is the presence of associated chronic liver disease due to chronic alcoholism or chronic viral hepatitis due to hepatitis B virus or hepatitis C virus. The associated severe systemic infection due to calculus cholecystitis or cholangitis due to common bile duct stones known as septicemia can also leads to the development of jaundice.

Another important point to be remembered is that the presence of associated viral hepatitis can have jaundice. The viral hepatitis patient present with nausea, fever, pain abdomen and jaundice. The presence of jaundice necessitates to perform an ultrasonography of abdomen to rule out biliary obstruction due to common bile duct stones or any other reason for biliary obstruction. Sometime patient with jaundice due to acute or chronic hepatitis can have stone in the gall bladder and cause of jaundice may not be related to gall stones. So, it is very important to identify the cause of jaundice in case of gall stone disease with jaundice to titrate the treatment plan for both gall stone disease and jaundice.