Obstructive JaundiceObstructive Jaundice

Michael RichardsonMichael Richardson

8/20/048/20/04

Obstructive jaundiceObstructive 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

LabsLabs

• 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)

Biliary Dilatation

Gallstone & Pancreatic duct

Pancreatic mass

Next step = ERCPNext step = ERCP

• Endoscopic retrograde cholangio-pancreatography

• Allows visualization of ampulla, imaging of bile and pancreatic ducts, and ampullary biopsy if desired

ERCP (cont.)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

Periampullary TumorsPeriampullary 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

Treatment & PrognosisTreatment & 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

ReferencesReferences

• Whipple images taken from http://www.cancerhelp.co.uk/help/?page=3124&order=1674

• Clincal information from www.uptodate.com