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Inflammation of gall bladder causing jaundice - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2009
Answered : 681 Questions
Doctor :   Hi
User :   hello
Doctor :   How can i help you today?
User :   i have some questions with regards to my fathers health
Doctor :   sure, please proceed
User :   last 2 weeks ago he became jaundice very fast
User :   so he had some basic blood test & an abdominal ultrasound
Doctor :   May i know his age, weight , height ?
User :   turning 70 this march
User :   he lost so much weight very fast
Doctor :   were the reports and tests normal ?
User :   no
Doctor :   can you explain the results ?
User :   can you tell me what test result do you want info with
User :   so i could give it to you
User :   i really wanted a 2nd opinion w/ this
Doctor :   i need the ultrasound results
Doctor :   as well as the liver function tests
User :   aside from the ultrasound he already undergone CT scan and some tumor marker
Doctor :   please mention the reports of the ultrasound and the CT scan
User :   ok
Doctor :   and if the tumor markers as well
User :   presence of moderately severe intra and extra- (CBD) hepatic biliary dilatations, suggestively from an occlusive process at the level of the head of pancreas (calculus vs. newgrowth)
User :   dilated gallbledder, w/ several gall stones
User :   small non-obstructed nephrolith left kidney
User :   moderately severe enlargement of the prostate, w/ features consistent w/ BPH
User :   CEA = 5.05
User :   PSA = 7.60
User :   CA19-9 = 601.10
User :   CT scan: Doctor :   ok
User :   intrahepatic and extrahepatic billiary dilatation, most likely from an ampullary (periampullary) nodule
User :   dilated gall bladder with cholelithesis
User :   prominent peripancreatic lymph node
User :   small renal cortical cyst
Doctor :   Ok, from the available results, it seems that the CT has not detected any tumors
Doctor :   it has just mentioned that there is obstructive lesion in the pancreatico- gall bladder duct system
User :   from the CT scan also: a suspicious hypodense nodule measuring 2.1cm is noted in the ampullary region
Doctor :   also, the presence of gall stones means that, the most probable cause of obstruction is a gall stone
User :   oh i forgot to mention that just 4 days ago he had the ERCP procedure
Doctor :   from the description, this could mean a few things, .......
Doctor :   1. lymph nodes due to associated inflammation around the area
Doctor :   2. a tumor originating from the pancreas or associated tissue, that could be blocking the Common bile duct
Doctor :   this obstruction has caused dilation of the bile ducts inside and outside the liver
Doctor :   the other causes of the obstruction could be the gall stones or fibrosis of the site where the ducts open into the intestines
Doctor :   the CAE increase , is very nominal and could be due to the cholecystitis or GB inflammation
User :   after the ERCP procedure the doctor told me that there was no stones or anything in the duct
Doctor :   CAE , with a grossly elevated value, greater than 5-10 times the upper limit of the reference normal range should be considered strongly suggestive for the presence of cancer . this value should be about 30-40 units of CAE
User :   that the one causing the obstruction was from the tumor inside the pancreas
Doctor :   BUT the value is 5.05 here and is not indicative of cancer
User :   and they put a stent for the passage of bile so his jaundice will be lessen
Doctor :   so when was the ultrasound done, and the CT done as well when was the ERCP done ?
Doctor :   since the ERCP has been already done, has his situation improved ?
User :   ultrasound was done 2/7/2011
User :   CT scan done : 2/15/2011
User :   ERCP 2/17/2011
Doctor :   ok
Doctor :   thanks for the info
Doctor :   has his condition improved after the procedure ?
User :   after the ERCP his yellowish skin already went back to normal a little
User :   but now he is complaining of bloating
Doctor :   what about the liver function tests , serum bilirubin etc ?
User :   he said that his stomach is like becoming so heavy
Doctor :   any procedures like a ERCP, can be associated with delayed intestinal motility and collection of gas
User :   ALT (SGPT) 115.00 U/L
Doctor :   you can give him activated charcoal tablets 500 mg 3 times daily
User :   ALK phosphatase: 596.00 U?L
Doctor :   this will reveal his bloating and abdominal discomfort
User :   Albumin: 44 g/L
Doctor :   Is this result of ALK, done after the procedure, if so, do you know his ALK, before the procedure?
User :   this was before
Doctor :   ok
Doctor :   so has the tests done after the ERCP ?
User :   i found the result after the ERCP
Doctor :   THERE should be a decrease in the ALK
User :   Abumin 475.70
Doctor :   is that the albumin or ALK ?
User :   sorry wait i type the wrong one
User :   total protein : 69.30
User :   albumin 35.36
User :   globulin 34
User :   A/G ratio 1.04
Doctor :   PLEASE mention the ALK PHOS
User :   total bilirubin 475.70
User :   direct bilirubin 303.19
User :   inderect 172.51
User :   im just looking for the ALK
Doctor :   ok
User :   i cant find it here all that was left is sodium, potassium, glucose, bun, crea, uric acid
User :   amylase & lipase
Doctor :   ok
Doctor :   amylase & lipase - are they ok ?
User :   amylase 1905.14
User :   lipase 2.99
User :   hemoglobin 11.3
User :   hematocrit 0.34
User :   RBC 3.47
User :   WBC 10.7
Doctor :   the amylase is a bit high
Doctor :   as well as the bilirubin levels
Doctor :   but this is likely due to the bile flow obstruction
User :   what does it mean?
Doctor :   the bile ducts that are dilated in the liver and outside the liver , have reduce the flow of bile into the intestine
Doctor :   hence this has caused the bilrubin to overflow into the blood
User :   the ERCP report says
User :   distal CDB stricture prob 2 to pancreatic head mass
Doctor :   ok , so finally here is the diagnosis, the CBD stricture
User :   in the distal common bile duct brushing for cystology the diagnoses was
Doctor :   the CBD stricture is the narrowing of the common bile duct
User :   strips of biliary epithelium with reactive nuclear changes and neutrophils, no definite malignant cells observe
Doctor :   this means that there is no malignancy in the CBD , and the changes are due to inflammatory changes
Doctor :   reactive nuclear changes and neutrophil - indicate inflammation User :   im so much confused cause the doctor said that it was definitely pancreatic cancer and that he can only have 3 weeks to maximum of 3 months
Doctor :   does the CT finding show any mass or tumor in the pancreas head ?
User :   the common bile duct is dilated w/ a sudden cut off at the ampulary region
User :   a suspicious hypodense nodule measuring 2.1cm is noted in the ampullary/periampullary region
Doctor :   Is it possible to scan and send the CT and ultrasound reports
User :   prominent peripancreatic lymph node is appreciated
User :   ok ill scan it
Doctor :   ok
Doctor :   that will be very good
Doctor :   I CAN SEE THE report and then revert back to you on your email ID
User :   give me a few minutes pls dr
Doctor :   SURE
User :   im just scanning and send it to you at once
Doctor :   sure
User :   Ct scan sent
User :   ERCP report next
Doctor :   it may take 5-10 min for me to recieve, due to the high server load, so please be patient while i recieve it
User :   what other report would you need?
Doctor :   those are enough
User :   no problem i can wait even the whole day
Doctor :   ok
User :   everything was already sent
Doctor :   no prb
Doctor :   i will read it as soon as i recieve it
Doctor :   and then chat further with you
User :   ok
User :   dr. a while ago you where asking me about CAE result I double check my result the what we have is CEA (colorecctal CA), PSA (prostatic CA) & CA19-9 ( pancreactic. which of the 3 where you were asking?
Doctor :   CEA
User :   the colorectal? 5.05 the one that is very much elivated was the tumor marker for the pancreas CA19-9, his was 601.10 and the said reference value here was 0-39
Doctor :   CA 19-9 is not sensitive or specific enough to use as a screening test for cancer, and it is not diagnostic of a specific type of cancer.
User :   that i do not know cause the doctor said that because it was really elevated so definitely pancreatic cancer
Doctor :   i got the mail
Doctor :   let me check it
User :   ok
Doctor :   ok
Doctor :   the CT and the ultrasound do not detect any abnormalitiy in the pancreas
Doctor :   the enlarged peripancreatic lymph node that is enlarged could be the cause of all the symptoms
Doctor :   the ERCP mentions that there is a pancreatic head mass, which is most probably due to the enlarged lymph node
Doctor :   There is in no way does all the reports indicate anything like a cancer in the pancreas
User :   really?! Oh my god!!
User :   and we were told that he only had 3 weeks to live
Doctor :   the CT and the Ultrasound do not indicate any mass in the PANCREAS
User :   so in your opinion doctor was is this?
Doctor :   this could be peripancreatic inflammation
User :   due to?
Doctor :   chronic inflammation associated with cholecystitis
User :   cholecystitis is the gallbladder?
Doctor :   yes
Doctor :   IT is the inflammation in the Gall bladder
Doctor :   as seen by the gall stones in the GB
User :   ok but will the inflammation of the head of the pancreas cause the obstruction?
Doctor :   since the ERCP and stenting has been done, the symptoms will subside
Doctor :   also the doctors statement that the life is less than 3 months is incorrect
User :   yes it already subside
Doctor :   as they have not detected any metastasis or any other lesions anywhere else in the body
User :   thats very good news
User :   what causes the bloating?
Doctor :   since the sympoms have decreased , he will recover soon
User :   but the bloating showed after the ERCP was already done
Doctor :   thats a side effect of the procedure
User :   oh... doctor thank you very very very much that is such a relife what you explained to me
User :   do you think that i let my father have a 2nd opinion w/ an oncologist?
Doctor :   you are most welcome
Doctor :   yes
Doctor :   that will give him more hope
User :   thank you so much again
Doctor :   you are most welcome
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