A 45 yr old lady, presented with history of pain abdomen for 4 weeks and jaundice for 5 days. USG revealed gallstones and a dilated CBD. Bilirubin was 5mg%, and SGOT/SGPT 102/88. Alkaline phosphatase was 481. The patient underwent MRCP, which also revealed dilated CBD till lower end, however, no CBD stone could be seen. What could be the diagnosis? How to proceed with the case?

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I agree which doctor Harish Modi Sir.

Eus should reveal small cal. Or stricture Passed out cbd stone is also likely

IF NO STONE IN CBD THINK OF EXTERNAL OBSTRUCTIVE PPATHOLOGY....CA HEAD OF PANCREAS. ADV FNAC USG GUIDED OF HEAD OF PANCREAS.

Kindly do CT abdomen Please ruleout carcinoma of head of pancreas Sphinter of oddi dysfuction, impaction of stones by sphinterotomy to be done. Radionuclide scanning .

MRCP can miss the small stones, Does gallbladder show any stones?? If yes , it will be CBD Stone with obstructive jaundice., Better to go with ERCP + Sphincterotomy + stone extraction and stenting..

How about doing EUS ?
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If clinically there is suspecion of Cholangitis or pancreatitis then better do EUS . As its dilated CBD till lower end the pathology must be distal where EUS can help to diagnose stricture, Malignancy, Parasitic infection.. Before EUS side viewing endoscopy can help for periampullary abnormality.

I agree with Dr. Zohaib

One could think of SOD sphincter of oddi dysfunction , stricture , CP with groove pancreatitis ( not the kind of patient ), autoimmune pancreatitis , parasitic infection , Cholesocal cyst, HIV biliopathy Probably an EUs and then blood investigations in this line

I agree
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This may be .ca head of pancreas investigate for tomou head of pencreas or ampulla of vatour if cnfirmed then whipples operation is advised

R/o ex cbd compression ie peri pancreatic or periportal lymphadenopathy may be simple or malignant

Thanx dr Avinashkumar Shrivastav
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