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Obstructive Jaundice

Obstructive Jaundice. Michael Richardson 8/20/04. Obstructive jaundice. LC is a 57 yo male who presents with painless jaundice Differential diagnosis (highest on list) Pancreatic carcinoma Ampullary adenoma Gallstones Liver disease Initial imaging – U/S followed by CT. Labs.

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Obstructive Jaundice

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  1. Obstructive Jaundice Michael Richardson 8/20/04

  2. Obstructive jaundice • LC is a 57 yo male who presents with painless jaundice • Differential diagnosis (highest on list) • Pancreatic carcinoma • Ampullary adenoma • Gallstones • Liver disease • Initial imaging – U/S followed by CT

  3. Labs • H&H – 10.1/30.1 • Amylase & Lipase – wnl • ALT/AST – 72/71 • Alk phos – 701 • T. bili/C. bili – 25.7/14.1 • Cancer Ag 19-9 – 268 (nl <37)

  4. Biliary Dilatation

  5. Gallstone & Pancreatic duct

  6. Pancreatic mass

  7. Next step = ERCP • Endoscopic retrograde cholangio-pancreatography • Allows visualization of ampulla, imaging of bile and pancreatic ducts, and ampullary biopsy if desired

  8. ERCP (cont.) • ERCP also allows placement of stent for biliary decompression • Main limitation of ERCP is it’s inability to view extension of tumor into duodenum or pancreatic parenchyma

  9. Periampullary Tumors • Can originate from pancreas, CBD, duodenum, or ampulla • Average age of presentation = 60-70 • Most common presentation = obstructive jaundice • Associated symptoms = nonspecific GI symptoms, steatorrhea, weight loss, fatigue

  10. Treatment & Prognosis • Whipple procedure • 5 yr survival = 65-80% if no nodes, 25-40% if positive nodes • 50% recur and ultimately die from ca • Better prognosis for those with true ampullary ca

  11. References • Whipple images taken from http://www.cancerhelp.co.uk/help/?page=3124&order=1674 • Clincal information from www.uptodate.com

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