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Published byRegina Stevens Modified over 9 years ago
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Obstructive Jaundice Michael Richardson 8/20/04
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Obstructive jaundice LC is a 57 yo male who presents with painless jaundice Differential diagnosis (highest on list) –Pancreatic carcinoma –Ampullary adenoma –Gallstones –Liver disease Initial imaging – U/S followed by CT
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Labs H&H – 10.1/30.1 Amylase & Lipase – wnl ALT/AST – 72/71 Alk phos – 701 T. bili/C. bili – 25.7/14.1 Cancer Ag 19-9 – 268 (nl <37)
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Biliary Dilatation
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Gallstone & Pancreatic duct
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Pancreatic mass
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Next step = ERCP Endoscopic retrograde cholangio- pancreatography Allows visualization of ampulla, imaging of bile and pancreatic ducts, and ampullary biopsy if desired
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ERCP (cont.) ERCP also allows placement of stent for biliary decompression Main limitation of ERCP is it’s inability to view extension of tumor into duodenum or pancreatic parenchyma
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Periampullary Tumors Can originate from pancreas, CBD, duodenum, or ampulla Average age of presentation = 60-70 Most common presentation = obstructive jaundice Associated symptoms = nonspecific GI symptoms, steatorrhea, weight loss, fatigue
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Treatment & Prognosis Whipple procedure 5 yr survival = 65- 80% if no nodes, 25- 40% if positive nodes 50% recur and ultimately die from ca Better prognosis for those with true ampullary ca
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References Whipple images taken from http://www.cancerhelp.co.uk/help/?page=3 124&order=1674 http://www.cancerhelp.co.uk/help/?page=3 124&order=1674 Clincal information from www.uptodate.com
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