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Old 04-10-2013
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Liver What causes this Jaundice?

66 year old male comes to hospital because he is not feeling well. He claims dark urine and pale stools for past 10 days. He also states that his skin is yellow since three weeks ago; which turns out to be painless jaundice. Examination of abdomem reveals no abnormalities. CT scan shows soft tissue in the head of the pancreas. Which of the following cause this jaundice?

A. Portal Hepatis metastases
B. Cholelithiasis
C. Common bile duct obstruction
D. Liver metastases
E. Pancreatic duct obstruction
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C. Common bile duct obstruction
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c pancreatic carcinoma can present with painless jaundice secondary to compression or obstruction of the common bile duct
as far as i remember q is from kaplan obank
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C -

bile duct obstruction
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Okay, what about Pancreatic duct obstruction? If there is mass, tumor, or soft tissue in the head of the pancreas; this picture doesn't involve the Pancreatic duct obstruction as well?
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Originally Posted by Doctor Ali View Post
Okay, what about Pancreatic duct obstruction? If there is mass, tumor, or soft tissue in the head of the pancreas; this picture doesn't involve the Pancreatic duct obstruction as well?
yes it may involve pancreatic duct as well
but its not the reason for jaundice
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So jaundice whether its pale stool, painless or painful - has literally nothing to do with pancreas. Even if pancreas goes into acute, chronic, or even adenocarcinoma of the head.

Jaundice whether its pale stoo, painless or painful - only involves problem some where along bilary tract to gallbladder, to liver, leaving pancreas intact. Even in case of adenocarcinoma of the head where there's tumor on the head = obstructing both bile secretion and pancreatic juice from entering into the Duodeum.

Correct?
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So jaundice whether its pale stool, painless or painful - has literally nothing to do with pancreas. Even if pancreas goes into acute, chronic, or even adenocarcinoma of the head.

Jaundice whether its pale stoo, painless or painful - only involves problem some where along bilary tract to gallbladder, to liver, leaving pancreas intact. Even in case of adenocarcinoma of the head where there's tumor on the head = obstructing both bile secretion and pancreatic juice from entering into the Duodeum.

Correct?


Look bro, pancreatic duct basically joins with common bile duct, so if there was like carcinoma of the pancreatic duct you would have the same symptoms too but those symptoms are secondary to the pancreatic carcinoma, the main reason u have jaundice and other symptoms is cause bile duct is obstruction, so ur billiburin secretion is backing up
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Smile This is a case of obstructive jaundice!!

This is a classic case of obstructive jaundice. Most common cause for obstructive jaundice is stone in the common bike duct, other cause is cancer in the head of the pancreas which will push second part of the duodenum and obstruct the common bile duct including the ampulla of Vater.

Key points to remember in obstructive jaundice are:
1. Predominantly elevated conjugated bilirubin
2. Tea colored (dark urine) with clay colored stool ( this is due to presence of conjugated (water soluble) bilirubin in urine and absence of urobilinogen (sometime referred as stercobilinogen) in the stools ( because urobilinogen is normally formed in the intestine, when there is obstruction to CBD there in no flow of bilirubin into intestine, hence no urobilinogen and hence clay colored stools!!).
3. Elevated levels of alkaline phosphatase, 5' Nucleotidase out of proportion to AST and ALT.


Secondary findings: deficiency of fat soluble vitamins (A,D,E,K) and essential fatty acids.
Hope this helps!!


Dr Mungli
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