R/o ex cbd compression ie peri pancreatic or periportal lymphadenopathy may be simple or malignant
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 .
Majority of the time such situation is due to a secondary stone impacted at the ampulla which has slipped or passed down, best is to wait for some time till CBD dilatation decreases or lft derangement returns back to normal, usually a mass lesion large enough to cause such cbd dilatation and LFT derangement will also be easily detected in MRCP, My suggestions will be to 1. Wait for 15days for LFT & CBD to settle down 2. If conditions further detioriate do ERCP + CBD stenting
As the CBD is dilated till the lower end and no stone the pathology must be at the distal part at the ampulla of vater. It can be malignancy ampulla of vater or may be cholangitis though it is not mentioned wheather pt is having temperature or not. Endoscopy can be done to to see the periampullary region fo any pathology.
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.
As Dr Sanglodkar said, CBD dilation till lower end and no stone detection on MRCP should lead to teo ways to approach ...First is EUS which is costly and unavailable at most centres and Second is to manually see the pathology by doin ERCP....and find out whats going on...
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
What is the patients general status? performance status ?did she loose weight? is she having goo symptoms...?what is the amylase or lipase level..? what is the ct abdo.en picture? whats the medical history? sphincter of oddi dysfunction should be ruled out...
If it is a case CA head pancreas then to have jaundice there must be pressure symptom on the CBD but CBD is although dilated till the end distallyso I don't think as a case of CA head pancreas.
This may be .ca head of pancreas investigate for tomou head of pencreas or ampulla of vatour if cnfirmed then whipples operation is advised
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52/female brought to casualty in drowsy state with c/o progressively increasing jaundice since 2 months for which they were taking some ayurvedic medicines from a quack. pt is non alcoholic, no h/o blood transfusion, fever, no h/o significant weight loss. o/e- drowsy, pulse- 110/min, BP- 90/60. spo2 98% on air. icterus, pallor and pedal edema present. P/A- liver palpable 4 cms and free fluid present. within 1 hour of admission she started with profuse malena and hematemesis. Ix showed Hb (6.8), TLC (10,300), Plt (4.17L), Total Bil (18), direct (10) indirect (8), OT/PT (265/121), Albumin (3.5),Globulin (3.1), serum ammonia 250, HBSAg, HCV negative, INR (1.8), Urea (46), creat (1.9), Na (145), K (2.9). Diagnostic Ascitic tap was done and report attached (ADA and cytology awaited). USG and CT abdomen attached. could it be malignancy? can obstructive jaundice present directly at this terminal stage? patient had no h/o abdominal pains before and had no h/o gall stones. Budd Chiari?Dr. Naved Memon6 Likes16 Answers
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29/M,single,. came with c/o of upper abdominal pain, vomiting 3 days..ch alcoholic. wt 49kg. cvs&other system-no obvious abnormality.. For ur suggestion pls..Dr. Sivanesan Ramayan3 Likes12 Answers
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Friends today I am discussing about Gall bladder stones. What are gallstones? Your gallbladder is a small organ below the liver in the upper right abdomen. It’s a pouch that stores bile, a green-yellow liquid that helps with digestion. Most gallstones form when there’s too much cholesterol in the bile. It’s not known exactly what causes gallstones to form, though there are some theories. Too much cholesterol in your bile Having too much cholesterol in your bile can lead to yellow cholesterol stones. These hard stones may develop if your liver makes more cholesterol than your bile can dissolve. Too much bilirubin in your bile Bilirubin is a chemical produced when your liver destroys old red blood cells. Some conditions, such as liver damage and certain blood disorders, cause your liver to produce more bilirubin than it should. Pigment gallstones form when your gallbladder can’t break down the excess bilirubin. These hard stones are often dark brown or black. Concentrated bile due to a full gallbladder Your gallbladder needs to empty its bile to be healthy and to function properly. If it fails to empty its bile content, the bile becomes overly concentrated, which causes stones to form. Symptoms Gallstones can lead to pain in the upper right abdomen. You may start to have gallbladder pain from time to time when you eat foods that are high in fat, such as fried foods. The pain doesn’t usually last more than a few hours. You may also experience: nausea vomiting dark urine clay-colored stools stomach pain burping diarrhea indigestion These symptoms are also known as biliary colic. Asymptomatic gallstones Gallstones themselves don’t cause pain. Rather, pain occurs when the gallstones block the movement of bile from the gallbladder. Complications and long-term risk Acute cholecystitis When a gallstone blocks the duct where bile moves from the gallbladder, it can cause inflammation and infection in the gallbladder. This is known as acute cholecystitis. It is a medical emergency. The risk of developing acute cholecystitis from symptomatic gallstones is 1 to 3 percent. Symptoms associated with acute cholecystitis include: intense pain in the upper stomach or mid-right back fever chills appetite loss nausea and vomiting See a doctor immediately if these symptoms last more than 1 to 2 hours or if you have a fever. Other complications Untreated gallstones may cause complications such as: jaundice, a yellowish tint to your skin or eyes cholecystitis, a gallbladder infection cholangitis, a bile duct infection sepsis, a blood infection pancreas inflammation gallbladder cancer Risk factors for gallstones Many risk factors for gallstones are related to diet, while some factors are uncontrollable. Uncontrollable risk factors are things like age, race, gender, and family history, which can’t be changed. Lifestyle risk factors Uncontrollable risk factors Medical risk factors being overweight or obese being female having cirrhosis eating a diet that’s high in fat or cholesterol or low in fiber being of medications for lowering cholesterol having diabetes mellitus being 60 years or older taking medications that have a high estrogen content While medications can increase your risk of gallstones, don’t stop taking them unless you have discussed it with your doctor and have their approval. How they’re diagnosed Your doctor will perform a physical examination that includes checking your eyes and skin for visible changes in color. A yellowish tint may be a sign of jaundice, the result of too much bilirubin in your body. The exam may involve using diagnostic tests that help your doctor see inside your body. These tests include: Ultrasound: An ultrasound produces images of your abdomen. It’s the preferred imaging method to confirm that you have gallstone disease. It can also show abnormalities associated with acute cholecystitis. Abdominal CT scan: This imaging test takes pictures of your liver and abdominal region. Gallbladder radionuclide scan: This important scan takes about one hour to complete. A specialist injects a radioactive substance into your veins. The substance travels through your blood to the liver and gallbladder. On a scan, it can reveal evidence to suggest infection or blockage of the bile ducts from stones. Blood tests: Your doctor may order blood tests that measure the amount of bilirubin in your blood. The tests also help determine how well your liver is functioning. Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a procedure that uses a camera and X-rays to look at problems in the bile and pancreatic ducts. It helps your doctor look for gallstones stuck in your bile duct. How are gallstones treated? Most of the time, you won’t need treatment for gallstones unless they cause you pain. Sometimes you can pass gallstones without even noticing. If you’re in pain, your doctor will likely recommend surgery. In rare cases, medication may be used. If you’re at high risk for surgery complications, a drainage tube may be placed into the gallbladder through the skin. Your surgery may be postponed until your risk is lowered by treating your other medical conditions. Natural treatment and home remedies If you have gallstones and no symptoms, you can make certain lifestyle changes. Tips for gallbladder health Maintain a healthy weight. Avoid rapid weight loss. Eat an anti-inflammatory diet. Get regular exercise. Take supplements as approved by your doctor. Some nutritional supplements you can take include vitamin C, iron, and lecithin. One review found that vitamin C and lecithin can decrease the risk of gallstones. Talk to your doctor about the appropriate dosage of these supplements. Some people recommenda gallbladder flush, which involves fasting and then taking olive oil and lemon juice to help pass gallstones. There is no evidence that this works, and it may even cause gallstones to become trapped in the bile duct. Surgery Your doctor may need to perform a laparoscopic gallbladder removal. This is a common surgery that requires general anesthesia. The surgeon will usually make 3 or 4 incisions in your abdomen. They’ll then insert a small, lighted device into one of the incisions and carefully remove your gallbladder. You usually go home on the day of the procedure or the day after if you have no complications. You may experience loose or watery stools after gallbladder removal. Removing a gallbladder involves rerouting the bile from the liver to the small intestine. Bile no longer goes through the gallbladder and it becomes less concentrated. The result is a laxative effect that causes diarrhea. To treat this, eat a diet lower in fats so that you release less bile. Nonsurgical treatments Medication is not commonly used anymore because laparoscopic and robotic techniques make surgery much less risky than it used to be. However, if you can’t have surgery, you can take ursodiol (Actigall, Urso) to dissolve gallstones caused by cholesterol. You’ll need to take this drug 2 to 4 times per day. Medications may take several years to eliminate the gallstones, and the gallstones may form again if you stop treatment. Shock wave lithotripsy is another option. A lithotripter is a machine that generates shock waves that pass through a person. These shock waves can break gallstones into smaller pieces. Foods to avoid To help improve your condition and reduce your risk of gallstones, try these tips: Reduce your intake of fats and choose low-fat foods whenever possible. Avoid high-fat, greasy, and fried foods. Add fiber to your diet to make your bowel movements more solid. Try to add only a serving of fiber at a time to prevent gas that can occur from eating excess fiber. Avoid foods and drinks known to cause diarrhea, including caffeinated drinks, high-fat dairy products, and very sweet foods. Eat several small meals per day. Smaller meals are easier for the body to digest. Drink a sufficient amount of water. This is about 6 to 8 glasses per day. If you plan to lose weight, do it slowly. Aim to lose no more than two pounds per week. Rapid weight loss may increase your risk of gallstones and other health problems. What can I expect in the long term? If you need surgery to remove your gallbladder or any stones in your gallbladder, the outlook is often positive. In most cases of stone removal, stones don’t return. But if you don’t have surgery, the gallstones can return. This is true even when you’ve taken medication to dissolve the gallstones. You won’t need treatment if your gallstones don’t cause symptoms. Still, you may want to make lifestyle changes to prevent them from getting bigger and causing problems. Gall bladder stone is indeed a painful condition. It can start in the abdominal area and spread to the spot below the right shoulder and can be quite excruciating. But have you ever thought or known the fact that the disease can be treated with homeopathy? Yes, homeopathy can do wonders in case of gall bladders stone. The obvious solution given by most specialists is the removal of your gall bladder. But with homeopathy, there is no need for such drastic measures. Moreover, not only will you save yourself from the loss of an organ but also your cost will be reduced by many folds. 1. Chelidonium Chelidonium is considered as one of the best remedies for gall bladder stones by many. This particular homeopathic medicine is most effective when there is a pain due to obstruction of the bile ducts due to the stones. Whenever you face a pain specifically under your right shoulder blade, then you should take Chelidonium. Many patients who experience gallbladder problems during the pregnancy months can also opt for Chelidonium as it is very effective. 2. Lycopodium Everyone experience different symptoms for gallstones, and for those who face acidity and a bloated abdomen can use lycopodium for relief. These patients usually face a distension of abdomen even if they eat a very small amount of food. What happens is that the gas keeps rolling in the abdomen and does not pass out easily. There are even acidity problems arising due to starchy food. It is at these times that Lycopodium proves to be a messiah. 3. Calcarea Carbonica This is the best homeopathy remedy for those who are suffering from gallstones and are obese. A lot of fat accumulates in the abdomen, and the patient can face problems of chronic constipation. Other symptoms include sensitivity to cold air and tremendous sweating on the head. The patient develops a particular dislike towards hot food. A patient may also experience sour vomiting due to the presence of gallstones. In such situations, Calcarea carbonica can really prove to be effective. 4. Nux Vomica When patients face tremendous acidity problems due to stones in the gall bladder that is when Nux Vomica proves to be helpful. These patients will experience nausea, sour burps and a feeling of stomach becoming heavy after eating. Nuz Vomica reduces all these symptoms. Any patient with spasmodic pain can take Nux Vomica. The pain that arises due to gall bladder stones will go away, and the stones will get dissolved with the help of homeopathy. Have a fair understanding regarding the medications available and consult a homeopathy specialist to avail the right treatment to get cured completely. It is important to follow the medications as prescribed to observe progress.Dr. Rajesh Gupta5 Likes7 Answers
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Friends today I am discussing about Gall bladder stones. Gallstones The gallbladder stores and releases bile which helps digest fats. Sometimes gallstones form in the gallbladder or bile ducts. Gallstones may cause pain. Treatment options include medication or surgical removal of the stones or the gallbladder itself. What are gallstones? Gallstones are stone-like objects that form in the gallbladder or bile ducts. Gallstones can be tiny (the size of a grain of sand), or may be as large as a golf ball. Depending on the symptoms, people who have gallstones may not need treatment, or they may need to take medication or have surgery to remove their gallbladder. If the stones are in the bile ducts, they usually need to be removed by endoscopy. What is the gallbladder? The gallbladder is an organ that resembles a small pear. It is located under the liver on the right side of the abdomen. The function of the gallbladder is to store and dispense bile, a fluid that is produced by the liver and helps digest fats in the foods you eat. Bile is made up of several substances, including bilirubin and cholesterol. The gallbladder is connected to the liver and the intestine by a group of ducts, including the hepatic duct, the cystic duct, and the common bile duct. When you eat, the gallbladder sends bile through the common bile duct into the intestine to help you digest food, particularly fatty foods. Who is at risk for gallstones? The following have an increased risk for developing gallstones: Women. People over the age of 40. People who have a family history of gallstones (relatives who have the disease). People who are overweight or obese. People who lose a great deal of weight in a short period of time. People who have diabetes. People with Crohn’s disease. People whose diet is high in fat and cholesterol. People who take drugs that lower cholesterol. How do gallstones form? There are 2 types of gallstones: pigment stones (made up of bilirubin) and cholesterol stones (made up of cholesterol). Most gallstones are cholesterol stones. Cholesterol gallstones can form when there is too much cholesterol or bilirubin in the bile. Gallstones can also develop if the gallbladder does not completely empty itself of bile. Pigment gallstones may form in people who have certain conditions, such as cirrhosis of the liver or blood disorders. What are the symptoms of gallstones? In many cases, people who have gallstones do not have any symptoms. These gallstones are known as "silent stones." The main symptom of gallstones is pain, which can last from several minutes to several hours. Pain can occur when gallstones move from the gallbladder into one of the ducts (the hepatic duct, the cystic duct, and the common bile duct). Gallstones that migrate can cause conditions such as acute cholecystitis(inflammation of the gallbladder), cholangitis (infection and inflammation of the bile ducts), and pancreatitis(inflammation of the pancreas). The pain may be located in the upper part of the abdomen, between the shoulder blades, or under the right shoulder. Other symptoms of gallstones include: Sweating Vomiting Fever A yellow tint to the skin (jaundice) Homeopathic medicines used for treating gall stones Calcarea carbonica: If you have a family history of kidney and gall stones, are anxious and slow, overweight with high deposits of triglycerides and cholesterol, then you would be given this medicine. Chelidonium: If you get pain in any or both of the two patterns pain originating under your right shoulder blade and pain in the upper right abdomen, which spreads to the back, you will be prescribed this one. Lycopodium: This medicine is usually recommended in case you have a family history of stones in kidney and gall bladder, along with other complications like, chronic digestive disorders, high cholesterol, gastric problems, constipation, peptic ulcers, gas and bloating. The patient may usually get biliary colic pains late in the afternoon. He or she may also get irritated easily, and hate contradicting opinions. Natrum sulphuricum: The patient may have any or some of the problems like chronic diarrhea, gall stone pain, asthma, chronic obstructive pulmonary disease, depression, obesity and problem in joints. On top of that the patient may be too sensitive to changes in humidity and weather. In such a case, Natrum sulphuricum is given. Nux vomica: If a patient suffers from nausea, colic pains, spasmodic pains, heartburn and acidity, gas and bloating, and takes too much of rich and oily food and drinks, then this medicine is used to treat gall stones for him or her.Dr. Rajesh Gupta7 Likes4 Answers
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Friends, I am presenting a very important case scenario for discussion. Let's go step by step: 35 years old lady, no comorbidities, good performance status, presented with obstructive jaundice for 1 month. Apart from icterus rest of the examination was normal. At presentation, s. Bill 10, ALP 300. MRCP and CECT films are presented. How to proceed further? If want further relevant investigation I'll provide.Dr. Kaushal Yadav4 Likes16 Answers