obstructive jaundice

29years postnatal mother day 36/ had right hypochndrium pain 1week back, diagnosed with gall stone and advised for lab cholecystectomy..but as a feeding mother I thought to get operated later as it was not emergency.. then after two days , picture is going like obstructive jaundice with symptoms of colacolor urine, severe pruritus, pale color stool, icteric also... CECT /Mrcp done... In Mrcp no obstruction in CBD... No documented evidence of obstruction..but clinical picture s like obstructive jaundice..LFT done ... Now I was advised for ERCP with sphincterotomy for obstructive jaundice... Pls give suggestions????Mrcp report lft, CECT attached

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It does not look like a case of obstructive jaundice as serum alkaline phosphatase label within normal range and MRCP and CT report also does not reflect any finding suggested for obstructive jaundice CBD not dilated, intra biliary cannels normal. It seem to be case of viral hepatitis suggested by deranged liver function test. Go for conservative treatment.

But hbsag and HCV negative sir...
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This patient has normal common bile duct and normal IHBR radicals, on MRCP Clearly, based on above finding there is no evidence of obstructive jaundice and there is absolutely no need of ERCP and stenting There is rise in liver enzymes and rise in serum bilirubin, it could indicate infection causing hepatitis, therefore all infection causing Hepatitis need to be tested Please do test for- anti-HAV IgM, and anti-HBc IgM, HBsAg, anti-HCVAb, anti-EBV IgM and anti-CMV IgM Post partum status and SGPT more than SGOT indicates that it could be autoimmune Hepatitis Please check for Antinuclear antibody ds DNA antibody Anti smooth muscle antibody Anti mitochondrial antibody

HYPERBILLIRUBINEMIA .. WITH .. CHOLELITHIASIS .. NEED'S .. GASTROENTEROLOGIST OPINION ..

Jaundice. Obstructive jaundice . Live 52 . PPI. Multivitamin. Glucose supplements. Symptomatic treatment.

Wait no urgency blood mrcp not indicative of urgency

Adv MRCP to rule out choledocholithiasis.

SUGGESTIVE. OF JAUNDICE MAYBE VIRAL..?? NEEDS FURTHER. EVALUATION

Ad Usg Abdomen CT scan Abdomen Further evaluation is required for diagnosis and treatment

Dr ajay

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