Jaundice: Ovais Qureshi FY1
Jaundice: Ovais Qureshi FY1
Jaundice: Ovais Qureshi FY1
History
38 Male
Progressive jaundice
Pruritus
Weight loss
Pale stools
No abdominal pain
No PR bleeding or hematemesis
No recent travel
PMH- Nil
FH-Nil
DH Nil
Allergies NKDA
Not an IVDU
On examination
Visibly jaundiced
Abdo exam
Soft non-tender
No hepatosplenomegaly
No palpable masses
HS 1+11 - 0
Respiratory
Chest clear
Good air entry , bilaterally
Jaundice
Pre hepatic
Hepatocellular
Obstructive
Differentials
Pre hepatic
Hepatic
Obstructive
Haemolytic anaemia
Viral hepatitis
Gallstones
Gilberts syndrome
CMV
Pancreatic cancer
Crigler-Najjar syndrome
EBV
Cholangiocarcinoma
ALD
Cirrhosis
Liver mets
Autoimmune hepatitis
Drug induced hepatitis
PSC
PBC
Choledochal cyst
Mirrizi syndrome
Investigations
Hb- 140
WCC 8.4
Albumin 38-----------------------39
Ca 19-9 65
CEA normal
AFP- normal
Na-141
K+- 4.5
Urea 8.0
Creatinine 91
INR- 0.9
PT- 10.3
APTT 1.09
Investigations
MRCP / MR liver
No gallstones,
No liver lesion
CT
ERCP
EUS
Cholangiocarcinoma
Epidemiology
Presentation
Jaundice
Pale stools
Dark urine
Pruritus
Hepatomegaly
Fever (20%)
Causes
Choledochal cysts
Industrial chemical exposure: chemicals used in the aircraft, rubber and woodfinishing industries have been implicated.
Investigations
Bloods
Bilirubin
ALP
Gamma GT
AST, ALT ,albumin and PT time are usually normal or minimally raised
Investigations
Imaging
MRCP -
ERCP
Endoscopic ultrasound
Treatment
Medical
Stenting will help relieve biliary obstruction, stents in situ for 3 months
Treatment
Surgical
Prognosis
Usually poor
Distal extrahepatic tumours 5yr survival of 40%, usual survival approx. 17-28
months.