New Onset of Painless Jaundice

Question 1

Biliary obstruction decreases bilirubin in the intestines decreasing ……… and resulting in the ………..

Answer 1

stercobilin , “clay-colored” stool.

Question 2

Conjugated/direct bilirubin, and consequently total biliru-
bin, will be………. in obstructive jaundice.

Answer 2

increased

Question 3

Alkaline phosphatase (AP) level will also be …….. indicating bile duct obstruction.

Answer 3

elevated

Question 4

……. is present in the cells
that line the bile ducts.

Answer 4

AP

Question 5

What Initial Imaging Is Recommended for Painful Jaundice?

Answer 5

RUQ ultrasound.

Question 6

…….. is more likely to be the definitive study when the presentation is painful jaundice since gallstones are usually the cause.

Answer 6

Ultrasound

Question 7

Triple-phase CT can detect

Answer 7

1- Detect pancreatic and periampullary masses
2- and provide vital information regarding the resectability of the mass.

Question 8

What Is the Role of Tumor Markers CA 19-9
and Carcinoembryonic Antigen (CEA)?

Answer 8

There are insufficient data to screening pancreatic cancer

Question 9

CEA is also elevated in

Answer 9

colorectal, breast, lung, ovarian, and prostate cancer .
in some benign conditions such as smoking and IBD

Question 10

What Is the Surgical Management of Pancreatic Head (or Periampullary)
Cancer?

Answer 10

pancreaticoduodenectomy called
Whipple procedure.

Question 11

Why Must the Duodenum Be Removed When Surgically Resecting a Pancreatic
Head Tumor?

Answer 11

The pancreas and the duodenum share the same blood supply (the pancreaticoduodenal arteries).

Question 12

Conditions Is a Whipple Performed?

Answer 12

Pancreatic Cancer
Cancer of the duodenum, cholangiocarcinoma,
ampullary carcinoma.

Question 13

The most common complication of whipple is a …….. and is best treated with ………..

Answer 13

delayed gastric
emptying (gastroparesis), metoclopramide

Question 14

Biliary obstruction associated with fever and pain may require………. due to concern for cholangitis

Answer 14

urgent/emergent biliary decompression

Question 15

Most common causes of malignant biliary obstruction:

Answer 15

Pancreatic cancer
Cholangiocarcinoma
Ampullary carcinoma

Question 16

Posthepatic causes jaundice

Answer 16

Choledocholithiasis
Acute cholangitis
Chronic pancreatitis
Mirizzi syndrome
Malignant biliary obstruction

Question 17

Prehepatic causes of jaundice

Answer 17

Hemolytic anemia
Gilbert’s syndrome

Question 18

Imaging to evaluate for mass/stricture:

Answer 18

RUQ ultrasound
Triple-phase abdominal CT
EUS

Question 19

Painless jaundice is more common in carcinomas arising from the head of the pancreas; new-onset diabetes may precede diagnosis of cancer; poor prognosis

Answer 19

Pancreatic carcinoma

Question 20

Malignancy arising from the ampulla of Vater; most common presentation is painless obstructive jaundice

Answer 20

Ampullary carcinoma

Question 21

Associated with sclerosing cholangitis, chronic parasitic infections, malignancy of the bile ducts usually present at advanced stage, highly lethal

Answer 21

Cholangiocarcinoma

Question 22

May cause biliary stricture, recurrent epigastric pain, malabsorption

Answer 22

Chronic pancreatitis

Question 23

Acute cholangitis should be suspected in patients who show evidence of

Answer 23

systemic inflammation (fever, chills, leukocytosis) and cholestasis (jaundice or elevated bilirubin).

Question 24

Reynold’s pentad

Answer 24

Charcot’s triad plus hypotension and mental status
changes.

Question 25

Elderly patients with cholangitis may remain asymptomatic until

Answer 25

they develop septic shock.