Obstructive jaundice Case presentation format
• NAME –Mrs X
• GENDER- Female
•
AGE- 54 Years
•
OCCUPATION- Housewife
• ADDRESS- Meerut, Uttar-Pradesh
•
SOCIO-ECONOMIC STATUS-
lower class( Modified
Kuppuswamy 2020)
CHIEF COMPLAINTS
• Yellowish discoloration of body and eyes from past 30 days
• Undocumented Fever from 20 days
•
Loss of appetite from past 20 days
•
Weight loss from past 20 days
History of presenting Illness
• Yellowish discoloration of eyes for 30 days – first noticed
by her son Gradually
progressive – no waxing/waning
Associated with –
-High colored urine and clay colored stools
-Generalized itching experienced 10 days after onset of jaundice
•
History of fever – undocumented, on and off, associated with chills and rigors, subsiding
on oral medication.
- Last episode-
• History of nausea present,
-no history
of vomiting.
-no history of post-prandial fullness
• History of loss of appetite x 20 days( earlier 3-4 chapatis /meal, now half chapati /meal)
• Undocumented weight loss( loosening of clothes)
• History of abdominal distention x 10 days
• No h/o prodromal symptoms/pain abdomen
• No h/o hematemesis/ malena
•
No h/o abnormal bladder
habits
•
No h/o altered sensorium
• No h/o seizures/ bleeding
• History of abdominal distention x 10 days
•
No h/o prodromal symptoms/pain abdomen
• No h/o hematemesis/ malena
•
No h/o abnormal bladder
habits
•
No h/o altered sensorium
• No h/o seizures/ bleeding
Past Medical and Surgical History:
• No h/o diabetes mellitus, hypertension, Pulmonary TB, no cardiac, respiratory or thyroid disease.
• No previous h/o jaundice
• No h/o blood transfusion
•
No h/o chronic drug intake
• No h/o surgery in the past.
Personal History:
• No h/o smoking, alcohol or tobacco intake
•
Sleep disturbed due to itching
•
No known allergies
Family History
Summary
54 year old female with
•
Painless progressive jaundice, itching, high colored urine and clay colored stools
• Undocumented Fever episodes
•
H/o nausea
• Loss of appetite
and weight loss
General Physical Examination:
•
Conscious, oriented,
cooperative, thin built, malnourished
• Weight-
• Height-
• BMI-
• ECOG score-
• Performance score-
• Vitals – Temp: 98.6 F
PR- 56 bpm
BP- 100/64 mmHg
Abdominal Examination:
INSPECTION-
• Distended, Bilateral flank
fullness present
•
Umbilicus midline,
central and inverted
•
Skin overlying abdomen- scratch marks present, no venous prominence, no nodules
• All quadrants moving
with respiration
•
No visible lump, no visible peristalsis
• Hernial orifices including external genitalia appears
normal
Palpation:
•
No local rise of temperature noted
• No tenderness
• A well defined globular lump of approx size- 5x 4 cm palpable in right hypochondriac region with smooth surface, firm consistency, moving with respiration, lateral and medial borders palapable with side-side mobility noted
•
Liver was palpable 13 cm below the costal margin
in mid clavicular line, regular
smooth surface, non tender,
firm consistency
• No nodularity
• No other lump palpable
PERCUSSION
•
Dull note over the lump, continuous with liver dullness
•
No shifting dullness
•
Liver span cm in mid
clavicular line and cm in anterior axillary
line
AUSCULTATION –
•
Normal bowel sounds heard
•
No bruit over the mass
DRE-
• Normal anal tone
• No growth palpable
•
No pelvic deposits felt
• Finger stained with faecal matter
Other systems examinations:
•
CHEST- bilateral air entry present,
no added sounds
• CVS- S1 S2 heard
•
CNS- higher
mental functions intact
Summary of the case:
• 54 year old female presented with gradually progressive, painless jaundice
associated with on and off fever and progressive loss of appetite and weight from past 20 days.
• On examination- icteric with pitting edema and a well defined globular lump in right hypochondrium likely to be a distended gall bladder with hepatomegaly and a liver span of 13 cm.
Provisional diagnosis:
•
MALIGNANT BILIARY
OBSTRUCTION
DIFFERENTIAL DIAGNOSIS-
1.
Pancreatic head carcinoma
2.
Peri-ampullary carcinoma
3.
Distal cholangiocarcinoma
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