S2D: The Symptom to Diagnosis Podcast Jaundice
May 4, 2021
Jaundice takes center stage as hosts delve into intriguing cases and clinical clues. They dissect a 65-year-old woman’s symptoms, highlighting the importance of distinguishing between conjugated and unconjugated bilirubin. The discussion navigates through diagnostic imaging choices and the urgent implications of jaundice paired with fever. Learn how liver enzyme patterns reveal underlying conditions, with fascinating insights into hepatocellular causes and the significance of urine color. The case conclusion uncovers an ampullary mass, leading to essential management strategies.
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Painless Jaundice Turned Out To Be Ampullary Cancer
- A 65-year-old woman presented with pruritus, pale stools, dark urine, and painless jaundice, which pointed to extrahepatic obstruction.
- Imaging found an ampullary mass and surgery cured her, illustrating that not all painless obstructive jaundice is pancreatic cancer.
Start By Classifying Jaundice
- Distinguish conjugated from unconjugated jaundice early using history, urine color, and a simple blood test.
- If urine is dark or stools are pale, prioritize conjugated causes and image the biliary tree promptly.
LFT Patterns Point To Mechanism
- Hepatocellular injury raises AST/ALT much more than alkaline phosphatase because dying hepatocytes release transaminases and leak conjugated bilirubin.
- Obstructive processes raise alkaline phosphatase (and GGT) more than AST/ALT, guiding imaging decisions.
