What is the diagnosis?

80 year male complaints of severe epigastric pain and nausea. He had similar 2 episodes in the last 2 months and he also had jaundice. He is only consuming boiled food. There is NO history of blood in stools. On USG abdomen - normal Following are his serial liver function reports What is the cause of the pain and what further tests can be done to come to a diagnosis

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Choledocholilithiasis . Obstructive jaundice is।caused followinv this. Choledocholithiasis (also called bile duct stones or gallstones in the bile duct) is the presence of a gallstone in the common bile duct. Gallstones usually form in your gallbladder. The bile duct is the small tube that carries bile from the gallbladder to the intestine. When gallstones get stuck in the bile ducts, it causes choledocholithiasis. Gallstones may vary in cause and type. Traditionally, gallstones are divided into three main types. These stones are typically brown pigment stones that form within the bile ducts, such as the common bile duct.
Successive LFTS suggest pt has obstructive jaundice Likely cause is (a) gall stone in cbd (b) ex billiary obstruction is compression Usually periportal lymphnodes More likely in this age Hence my suggestion to r/o malignancy Adv usg abd Ct abdomen Sr amylase And rest of lab work Suspicious lesions will need biopsy
Thanx dr Pushkar ji Bhomia
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Acute Cholecystitis
It’s choledocolithiasis. Go for MRCP for confirmation as Bilirubin can’t be raised without obstruction. Then go for ERCP for management or lap choledocoscopy and management.
History and lab reports s/ o obstructive jaundice most likely due to choledocholithiasis. Can go directly for ERCP upfront to diagnose and treat.
Hepatitis ,? Viral ,recovering . ? Alcoholic hepatitis , ? NAFLD Suggest viral hepatitis profile , abdominal ultrasound .
Obstructive jaundice. Go for MRCP for diagnosis.
Cholestastic bile duct obstructive jaundice

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