48-year-old woman c jaundice - hopeofglory87

[ArchivalUser]

A 48-year-old woman has had right subcostal heaviness, intermittent pain, and food intolerance for 2 months. The pain has increased and shifted to her back. She has lost 6kg (13.2lb). One week ago she experienced jaundice and low-grade fever. Past medical history is remarkable for perforated appendicitis and peritonitis 20 yrs ago. She has epigastric tenderness and a round mass is palpable 5 cm below the right costal line. Murphy™s sign is negative. Abdominal ultrasound is positive for enlarged gall bladder, without stones, and widening of hepatic ducts. Her pancreas is not visualized because of gas collections in the bowels.
Laboratory results are:
WBC 11,000/cmm
Bilirubin total/direct 2.0/1.1 mg/dL
ALT 87mg/dL
AST 56mg/dL
Alkaline phosphatase 210mg/dL
Amylase 140
Which of the following is the most appropriate next step in the management?
A.Plain abdominal film
B.Endoscopic retrograde cholangiopancreatography
C.Percutaneous transhepatic cholangiography
D.CT of abdomen
E.HIDA scan

[ArchivalUser]

bb

[ArchivalUser]

bb

[ArchivalUser]

why B?
What do U think is the possible diagnosis

[ArchivalUser]

jaunduce ,pain,fever =charcot triad,for decompression(diagnosis+t/m)-ercp after us

[ArchivalUser]

D. Ca head of pancreas most likely. CT Ix of choice for visualising pancreas.

[ArchivalUser]

sgarson, how do you know this is pancreas head ca??
I think it cud be any one of the periampullary cancer
They all present with the same symptoms and Physical

[ArchivalUser]

abd usg can detect dilation of intra and extahepatic biliary tree, biliary dilatation suggests extrahepatic cholestasis. DDx 1) malignannt such as cholangioca, pancreatic ca, gallbladder ca, 2) benign such as choledocholithiasis, 1 sclerosing cholangitis, chr pancreatitis. next step is to do ERCP if CBD is not visualized due to USG. ERCP is d gold std for choledocholithiasis. ans is B, do ercp

[ArchivalUser]

For periampullary ca.
Whats the diagnostic tool?
initially it's sono, then is it CT or ERCP?
For pancreas head ca : sono -> CT -> ERCP
What about the others?

[ArchivalUser]

It could be any malignancy affecting the ampulla, but ca pancreas more likely given site of pain, radiating to back. A hunch..not very scientific. Right or wrong???