Ghazanfar Zulfiqar Roll no.

22 Topic: Hepatobilliary disorders

Case :

A 50 years old male presenta with the complaint of itching all over the body yellow
discolouration of the body, dark yellow urine, and clay colored stools for last one month. He is
diabetic,hypertensive, and had a cronory stent 4 years back. Lost 5kg weight during this
period.His examination is unremarkable.
Serum Bilirubin is 21 mg/dl, TLC 14000/mm, serum creatinine 1.9.

1-What would be the possible cuases of the disease?

Ans. Cuases of the jaundice can be divided into

a. Pre-hepatic jaundice
i. Hemolytic anemia of any cause
ii. Non hemolytic causes
1. Gilbert's syndrome
b. Hepatocellular jaundice
i. Hepatitis
ii. Autoimmune diseases
iii. Wilson’s disease
iv. Haemochromatosis
c. Post hepatic (obstructive) jaundice
i. Primary biliary cholangitis
ii. Sclorising cholangitis
iii. Alcohol / drugs
iv. Infection
v. Choledocholithiasis
vi. Carcinomas
vii. Strictures /pancreatitis
2.What further work up is necessary and why?
Ans. Investigations are done in a stepwise approach to find out cause
A. LFTs--- to know liver status
B. Urine for Bilirubin
C. Liver ultrasound for any kind of fluid, stone, tumor,
D. CBC and ESR for any hemolytic cause
E. Hepatitis profile for hepatitis
F. Immunoglobulin for Autoimmune diseases
G. Copper & iron studies for Wilson and haemochromatosis
H. ERCP /MRCP for the anatomy of biliary tract
Ans.
3.In the light of your diagnosis, what plan you would advice?
● General measures
○ Adequate nutrition
○ Hygiene maintenance
○ Avoid overcrowding
○ Maintain electrolyte balance
○ Early recognition and prompt treatment
○ Vaccination and prophylactic antibiotics

● Hemolytic anemia
○ In treat underlying disease
○ Splenectomy + folic acid+ blood transfusion + avoidance of precipitating factors
● Hepatocellular jaundice
○ For hepatitis supportive treatment / interferons/direct acting antiviral drugs
○ Glucocorticoid for autoimmune disease
○ Venesection for haemochromatosis
○ Penicillamine for Wilson
● Obstructive jaundice
○ Surgery is the best option
4. See the attached image name the intervention and give three imp findings?
Ans.
Name of the intervention is Endoscopic retrograde cholangiopancreatography
(ERCP) and it shows
● Dilatation of biliary tract
● Stone in biliary duct (Choledocholithiasis)