1. Obstructive Jaundice Michael Richardson 8/20/04

2. Obstructive jaundice LC is a 57 yo male who presents with painless jaundice Differential diagnosis (highest on list) –Pancreatic carcinoma –Ampullary adenoma –Gallstones –Liver disease Initial imaging – U/S followed by CT

3. Labs H&H – 10.1/30.1 Amylase & Lipase – wnl ALT/AST – 72/71 Alk phos – 701 T. bili/C. bili – 25.7/14.1 Cancer Ag 19-9 – 268 (nl <37)

4. Biliary Dilatation

5. Gallstone & Pancreatic duct

6. Pancreatic mass

7. Next step = ERCP Endoscopic retrograde cholangio- pancreatography Allows visualization of ampulla, imaging of bile and pancreatic ducts, and ampullary biopsy if desired

8. ERCP (cont.) ERCP also allows placement of stent for biliary decompression Main limitation of ERCP is it’s inability to view extension of tumor into duodenum or pancreatic parenchyma

9. Periampullary Tumors Can originate from pancreas, CBD, duodenum, or ampulla Average age of presentation = 60-70 Most common presentation = obstructive jaundice Associated symptoms = nonspecific GI symptoms, steatorrhea, weight loss, fatigue

10. Treatment & Prognosis Whipple procedure 5 yr survival = 65- 80% if no nodes, 25- 40% if positive nodes 50% recur and ultimately die from ca Better prognosis for those with true ampullary ca

11. References Whipple images taken from http://www.cancerhelp.co.uk/help/?page=3 124&order=1674 http://www.cancerhelp.co.uk/help/?page=3 124&order=1674 Clincal information from www.uptodate.com