Case 11: Jaundice Patient

General
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Patient was a 68-year-old male who complained of weight loss, boring pain in right
hypochondrium, skin itching, discharge of acholic faeces and deep-brown urine.
Inspection showed icteric scleras and greenish-yellow colour of the skin. Palpation
of abdomen revealed enlarged soft-elastic tender gallbladder in its point.

  1. What type of jaundice did the patient have?
  2. What is the most probable cause of this jaundice?
  3. Name the symptom revealed by palpation of gallbladder.
  4. List additional methods and their possible results that confirm the type of
    jaundice recognized by you.
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Obstructive jaundice most probably due to cholelithiasis
Investigation: liver function test
Treatment: cholecystectomy

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  1. Type of jaundice: Obstructive (cholestatic) jaundice
  2. Most probable cause:pancreatic carcinoma
  3. Symptom revealed by palpation of gallbladder: Courvoisier’s sign – enlarged, non-tender gallbladder
    Ultrasound: dilated bile ducts, mass in pancreas
    CT/MRI: confirms mass and obstruction
    MRCP/ERCP: visualizes bile duct blockage
    Liver function tests: increased conjugated bilirubin, ALP, GGT
    Tumor marker: raised CA 19-9
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Type of Jaundice: Obstructive jaundice.

Probable Cause: Obstruction of the common bile duct (likely due to tumor or gallstones).

Symptom: Courvoisier’s sign (enlarged, palpable gallbladder).

Additional methods: Ultrasound, CT scan, ERCP, and blood tests (bilirubin, ALP, GGT).

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The patient is likely experiencing obstructive jaundice. The most probable cause is a blockage in the common bile duct, potentially due to gallstones or a tumor. The palpable, tender, enlarged gallbladder is known as Murphy’s sign. Additional tests like an abdominal ultrasound, blood tests, and possibly ERCP can confirm the obstruction.

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