New Onset of Painless Jaundice Flashcards
Biliary obstruction decreases bilirubin in the intestines decreasing ……… and resulting in the ………..
stercobilin , “clay-colored” stool.
Conjugated/direct bilirubin, and consequently total biliru-
bin, will be………. in obstructive jaundice.
increased
Alkaline phosphatase (AP) level will also be …….. indicating bile duct obstruction.
elevated
……. is present in the cells
that line the bile ducts.
AP
What Initial Imaging Is Recommended for Painful Jaundice?
RUQ ultrasound.
…….. is more likely to be the definitive study when the presentation is painful jaundice since gallstones are usually the cause.
Ultrasound
Triple-phase CT can detect
1- Detect pancreatic and periampullary masses
2- and provide vital information regarding the resectability of the mass.
What Is the Role of Tumor Markers CA 19-9
and Carcinoembryonic Antigen (CEA)?
There are insufficient data to screening pancreatic cancer
CEA is also elevated in
colorectal, breast, lung, ovarian, and prostate cancer .
in some benign conditions such as smoking and IBD
What Is the Surgical Management of Pancreatic Head (or Periampullary)
Cancer?
pancreaticoduodenectomy called
Whipple procedure.
Why Must the Duodenum Be Removed When Surgically Resecting a Pancreatic
Head Tumor?
The pancreas and the duodenum share the same blood supply (the pancreaticoduodenal arteries).
Conditions Is a Whipple Performed?
Pancreatic Cancer
Cancer of the duodenum, cholangiocarcinoma,
ampullary carcinoma.
The most common complication of whipple is a …….. and is best treated with ………..
delayed gastric
emptying (gastroparesis), metoclopramide
Biliary obstruction associated with fever and pain may require………. due to concern for cholangitis
urgent/emergent biliary decompression
Most common causes of malignant biliary obstruction:
Pancreatic cancer
Cholangiocarcinoma
Ampullary carcinoma
Posthepatic causes jaundice
Choledocholithiasis
Acute cholangitis
Chronic pancreatitis
Mirizzi syndrome
Malignant biliary obstruction
Prehepatic causes of jaundice
Hemolytic anemia
Gilbert’s syndrome
Imaging to evaluate for mass/stricture:
RUQ ultrasound
Triple-phase abdominal CT
EUS
Painless jaundice is more common in carcinomas arising from the head of the pancreas; new-onset diabetes may precede diagnosis of cancer; poor prognosis
Pancreatic carcinoma
Malignancy arising from the ampulla of Vater; most common presentation is painless obstructive jaundice
Ampullary carcinoma
Associated with sclerosing cholangitis, chronic parasitic infections, malignancy of the bile ducts usually present at advanced stage, highly lethal
Cholangiocarcinoma
May cause biliary stricture, recurrent epigastric pain, malabsorption
Chronic pancreatitis
Acute cholangitis should be suspected in patients who show evidence of
systemic inflammation (fever, chills, leukocytosis) and cholestasis (jaundice or elevated bilirubin).
Reynold’s pentad
Charcot’s triad plus hypotension and mental status
changes.
Elderly patients with cholangitis may remain asymptomatic until
they develop septic shock.
