Obstructive Jaundice Post-Cholecystectomy — FRCA Final MCQ

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EasyGeneral AnaesthesiaObstructive Jaundice Post-CholecystectomyFRCA Final

A 40-year-old man (ASA I) undergoes laparoscopic cholecystectomy. The surgeon inadvertently clips the common bile duct. This is not recognised intraoperatively. Post-operatively he develops progressive jaundice, dark urine, and pale stools. What type of jaundice is this?

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Correct answer: A — Post-hepatic (obstructive/cholestatic)

Common bile duct clipping/injury causes post-hepatic (obstructive) jaundice. Bile cannot drain into the duodenum, causing: conjugated (direct) hyperbilirubinaemia, elevated ALP and GGT (cholestatic enzymes), dark urine (conjugated bilirubin is water-soluble and excreted renally), pale stools (absent urobilinogen/stercobilin), and pruritus (bile salt deposition in skin). ALT may be mildly elevated from back-pressure damage to hepatocytes. Diagnosis: ultrasound showing dilated bile ducts, confirmed by MRCP. Management: ERCP with stenting or surgical repair.

Reference: NICE – 2014 – CG188 Gallstone disease; RCOA – 2023 – Hepatobiliary anaesthesia