Ch. 18 New Onset of Painless Jaundice Flashcards
What is Courvoisier’s Sign?
Presence of a palpable RUQ mass, which represents a non-tender, enlarged gallbladder
Signifies obstruction, most often of the distal CBD, causing the biliary tree and the gallbladder to markedly distend, and is most commonly seen with malignancy (pancreatic, ampullary, or bile duct)
- Sister Mary Joseph Nodule?
- Blumer’s Shelf?
- Sister Mary Joseph Nodule?
- Periumbilical mass signifying possible metastatic abominal (or pelvic) malignancy
- Most often seen with GI malignancies (e.g., stomach, pancreatic)
- Blumer’s Shelf?
- Step-off during rectal exam suggesting metastatic disease to the pouch of Douglas
- Usually site of metastasis of cancers of the lung, pancreas, stomach
What is the mechanism behind “clay-colored” stools?
Stool derives its brown color from stercobilin, a final product of bilirubin metabolism in the intestine. Biliary obstruction decreases bilirubin in the intestines, decreasing stercobilin –> “clay-colored” stool
If a pt has resectable pancreatic cancer, what is the course of action in terms of mgmt
Neoadjuvant chemo –> Whipple
Increased INR (PT) with Pancreatic Cancer
Bile is necessary for absorption of vitamin K in the GI tract
Any disease process that leads to prolonged biliary obstruction (such as pancreatic cancer) will cause vitamin K deficiency and therefore a prolonged INR
Treatment: parenteral vitamin K (if pt is not actively bleeding) or FFP (if pt is actively bleeding or needs immediate correction)
Categories of Jaundice:
Prehepatic
Hepatic
Posthepatic
Categories of Jaundice:
Prehepatic
- Hemolytic anemia
- Gilbert’s
Hepatic
- Ischemic liver injury
- Hepatic viral infection
- Toxic ingestion
- PBC
- PSC (mixed hepatic and posthepatic)
- Hepatolenticular degeneration (Wilson’s)
Posthepatic
- Choledocholithiasis
- Acute cholangitis
- Chronic pancreatitis
- Mirizzi syndrome
- Malignant bilary obstruction
- pancreatic cancer
- cholangiocacinoma
- ampullary carcinoma
