Case of Jaundice under evaluation

A 50 year old female from rural area reported to my clinic on 7.07.2021 and then today 28.07.2021 Chief Complaints She reported on 7th with complaints of abdominal bloating/heaviness, decreased appetite etc from last 1 months History Cholecystectomy done 1 year back Investigations On 7.07.2021 her Serum Bilirubin was 22.18, SGOT - 70 ,SGOT- 72, Hb - 8.9%, I had advised to get all blood tests done with viral makers along with USG - W/A 28.07.2021 reports attached below Management At that time on 7th, I had advised her the following like UDCA 450 BD, PPI + Prokinetic, Pre-Probiotics, Liver tonic etc Kindly guide me as per reports of today and the USG W/A too I am thinking for refer the case to surgeon, as it fits for him/her Your opinion/recommendations needed

(Edited)

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As cholecystectomy has been done - unlikely to be CBD calculus as the cause of obstructive jaundice in this case. A peri-,ampullary carcinoma or a CBD structure lower end - cholangiocarcinoma or a benign structure is a possibility. A MRCP is urgently indicated for further evaluation for treatment part

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Total bilirubin of 22.18 with sonography showing Intrahepatic biliary dilatation This is suggestive of severe obstructive jaundice. Stones do not usually cause severe obstructive jaundice. It is likely to be pancreatic or duodenal malignancy which is the cause of obstructive jaundice Adv MRCP CT SCAN of Abdomen and pelvis with contrast

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Reports on 7 th seems to be case of viral hepatitis so viral markers was advised but when USG reports was available it seems to be case of obstructive jaundice suggested by dilatation of CBD with back pressure changes leading to dilatation of the intrahepatic biliary channel . Causes of obstruction considering the age A. Peri ampullary carcinoma B. Growth in CBD C left over stone in CBD D. External pressure on CBD MRCP will lead to the final diagnosis then to take up treatment accordingly.

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Obstructive Jaundice with Anemia with abnormal LFT with h/o. Cholecystectomy with Negative Viral Markers: Rule out cause of obstruction? Suspected Malignancy? Adv. MRCP : must Refer the case to Surgeon/ Hepatologist / Oncologist for concerned needful.

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Right you are MRCP oe ERCP either left out cbd stone or stricture pancreaticpathology should also be tuled out

Thank you doctor
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Kindly do MRCP oR ERCP Look for GB or CBD stone or structure Look for head of pancrease pathology

Thank you doctor
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PBC most likely. Adv GI Referral for Anti-mitochindrial antibodies, ANA, CT abdomen, liver biopsy.

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As per sonography intrahepatic billary dialation with distal proximal and mid portions of CBD ... Advised MRCP and ERCP CT abdomen with contrast Ext.pressure on CBD? Growth in CBD? Left over stone in CBD CBD stricture?

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NEED'S .. MRCP SCANS ..

Tnx &wc Dr Ajeet Pal Singh
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Should be ref to GIT Surgeon

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