Thursday, February 11, 2010

A 66 yo white female presented to the urgent care with 10 days of of increasing pruritus (itchy skin all over), yellowing skin and white part's of eyes, and pale stool. She is admitted to the hospital because of jaundice. The patient has felt fine and her only complaint is being itchy. She has no past medical history and has never been hospitalized in the past. She has never had any history of gallstones, hepatitis or cirrhosis. She had never smoked and rarely drinks alcohol. Physical exam is essentially normal except for discoloration of skin and scleral icterus. She had no abdominal pain on exam. She had tons of labs done but I'm just including LFT's:

Results Units Reference Range

TOTAL BILI 7.2 H mg/dL .2-1.2

DIRECT BILI 4.8 H mg/dL .0-.3

ALBUMIN 3.1 g/dL 3.1-4.7


ALT (SGPT) 305 HH IU/L 4-42

AST (SGOT) 257 H IU/L 10-39

TOTAL PROTEIN 7.3 g/dL 6.0-8.0
Which of the following diagnoses is most probable and which, if present, has the worst/best prognosis?
A. Choledocholithiasis
B. Pancreatic cancer
C. Klatskin tumor
D. Liver cirrhosis due to a combination of hep B and C
E. Gallbladder cancer