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Part 1 Final

Part 1 Final. The Curious Case of John Dick. Group 3 Clinical Clerk Batch 2012 S Y 2011-2012. Objectives. To discuss an intriguing case of an elderly woman with abdominal pain To elaborate on the approach to jaundice To discuss the diagnostic approaches to jaundice

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Part 1 Final

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  1. Part 1 Final

  2. The Curious Case of John Dick Group 3 Clinical Clerk Batch 2012 SY 2011-2012

  3. Objectives • To discuss an intriguing case of an elderly woman with abdominal pain • To elaborate on the approach to jaundice • To discuss the diagnostic approaches to jaundice • To present the management of obstructive jaundice and review therapeutic options

  4. Identifying Data • L.S. • 64-year-old • Widow • Vegetable vendor • Tondo, Manila

  5. Chief Complaint Generalized jaundice of 1 month duration

  6. Temporal Profile Weight loss Loss of appetite Tea-colored urine Colicky Abdominal Pain Jaundice 6 mos PTA 4 wks PTA 2 wks PTA 1 wk PTA 4 days PTA Admission

  7. Past Medical History: • Osteoarthritis, right ankle – took unrecalled medication for 1 month • Exposure to Tuberculosis • G4P4 (4004) via NSD without complications • No history of cancer • No history of heart failure or valvular defects • No history of Hepatitis B or C • No hemolytic disorders • No dyslipidemia • No history of blood transfusion • No history of needle prick injury • No history of prolonged or high-dose intake of drugs (e.g. Quinacrine, Rifampicin, etc) • No previous hospitalization, surgery, dental surgery

  8. Family History • Tuberculosis – Mother • No history of Cancer • No history of hemolytic disorders • Social History: • Non-smoker, non-alcoholic beverage drinker • No IV illicit drug use

  9. Review of Systems • Weight loss (~50 kg  ~36 kg in 1 month) • No weakness • No persistent cough, night sweats, hemoptysis, fever • No edema, difficulty of breathing, orthopnea • No breast lump, pain or discharge • No abnormal vaginal bleeding • No history of abdominal trauma, changes in bowel movement, nausea and vomiting, fatty food intolerance

  10. Physical Examination

  11. Physical Examination

  12. Physical Examination

  13. Pertinent Findings

  14. Pertinent Findings

  15. Assessment • Primary Impression • Obstructive Jaundice secondary to Pancreatic Head Mass • Differential Diagnoses: • TB Lymphadenitis • Peribiliary cancer • Choledocholithiasis

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