OnlineMedEd: Surgery: General - "Obstructive Jaundice"

Question 1

Review the three types of jaundice and what each could be.

Answer 1

•Prehepatic (indicated by elevated unconjugated/indirect bilirubin):

• Hemolysis
• Hematoma

•Intrahepatic (mixed bilirubin):

• Hepatitis
• Genetic (Crigler-Najjar, Dubin-John, Gilbert)

•Posthepatic (conjugated/direct bilirubinemia):

• Gallstones
• Strictures
• Cancer

Question 2

Choledocholithiasis and cholecystitis both present with ________________.

Answer 2

positive Murphy’s sign, fever, and leukocytosis

Question 3

How should you work up and treat suspected choledocholithiasis?

Answer 3

In a patient with fever, positive Murphy’s, and jaundice, get:

1) RUQ US
2) MRCP (if US indeterminate)
3) ERCP

Question 4

______________ can present with a massively dilated bile duct due to the slow-growing nature.

Answer 4

Strictures from pancreatic cancer

Question 5

How should you work up suspected pancreatic cancer?

Answer 5

In a patient with painless jaundice who has no fever, a negative Murphy’s, and no leukocytosis, get:

1) RUQ US
2) MRCP

Question 6

In addition to painless jaundice with no fever or leukocytosis, those with pancreatic cancer can present with ________________.

Answer 6

weight loss, night sweats, a distended gallbladder, and clay-colored stools

Question 7

What are the weird signs and symptoms of pancreatic cancer?

Answer 7

Migratory thrombophlebitis

Question 8

You can use ERCP to biopsy which kind of biliary cancer?

Answer 8

Cholangiocarcinoma because it is in the lumen

Pancreatic cancer requires endoscopic US because it is around the bile duct.