Question of the Week # 214

214 )  A 58 year old woman presents to the office because  her friend noticed that she looked yellow and asked her to seek medical attention. Lately, her urine has turned dark yellow but she thought it was because of reduced fluid intake. She has lost 10lb weight in the last 3 months. She denies any abdominal pain, nausea or vomiting. She denies any fever. She smoked about 2 packs per day for the past 30 years. She quit smoking 1 month ago. Physical examination reveals profound scleral icterus. Laboratory investigations reveal a Hemoglobin 10gm%, MCV 88, Total Bilirubin 17gm% , Direct bilirubin 13gm%, AST 120U/L, ALT 110U/L and ALP 600U/L. A CT scan of the abdomen does not show any mass in the pancreas. Ultrasound of the abdomen reveals common bile duct diameter of 12mm. Which of the following is the most appropriate next step in management?

A) CA 19-9 level

B) Endoscopic Retrograde Cholangiopancreatography

C) CT guided biopsy of Pancreatic Head

D) Percutaneous Biliary Stent

E) Haptoglobin level

9 Responses

  1. B – ercp?

  2. B

  3. B

  4. bbb

  5. C

  6. B

  7. B:) obstructive jaudice with dilation of CBD. No mass was found on CT.. It can be periampullary carcinoma. with ERCP, biopsy can be taken as well as stent can be placed if there is stricture to relieve obstruction.

  8. B

  9. C
    Please post d correct answer

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