Clinical case presentation on obstructive jaundice due to carcinoma head of pancreas

1. Case Presentation
Dr Md. Tafazzul Hossain Bhuiyan
FCPS Trainee
Dept of surgery
DMCH

2. Particulars of the patient
• Name: Mr Sohor Ali
• Age: 55 years
• Sex: Male
• Address: Jhenaidah
• Marital status: Married
• Occupation: Ricksapuller
• Religion: Islam
• Date of examination: 20/08/2023

3. Presenting complaints
• Yellow discoloration of eyes and skin for 3 months
• Itching all over the body for 3 months
• Pain in upper abdomen for 3 months
• Weight loss for same duration

4. History of presenting illness
According to patients statement he was relatively well 3 months back.
The he noticed yellow discoloration of eyes and skin which was
gradually increasing day by day. He also complaints of itching all over
the body for last 3 months. He also gave history of dark urine and pale
stool. He developed pain in upper abdomen which was gradual in onset
dull aching in nature and continuous. The pain doesn’t radiate to other
site and aggravated by taking food and relived by taking medicine. He
also has history of significant weight loss about 40% of his body weight.
His bowel and bladder habit is normal. He has no history of vomiting,
fever, bleeding during defecation. He has no DM,HTN, BA.

5. Past history
• No significant past medical or surgical history

6. Drug history
• He used to take anti ulcerant occasionally

7. Personal history
• He used to smoke 20 cigarettes per day for 35 years
• Betel leaf and betel nut chewer
• Non alcoholic

8. Family history
• His father and mother died naturally
• His brothers and sisters are in good health
• None of his family members has history of suffering from this or other
type of illness

9. Socio economic history
• Lives in tin shed kacha house
• Uses sanitary latrine
• Drinks tube well water
• Low socio economic condition

10. Immunization history
• Immunized against COVID 19
• Couldn’t give other immunization history

11. Allergic history
• He is not allergic to any food or medicine he took so far

12. Transfusion history
• He has no history of blood transfusion

13. General examination
• Appearance: ill looking
• Body built: below average
• Cooperation: cooperative
• Decubitus: on choice
• Nutritional status: poor
• Anemia: present
• Cyanosis: absent
• Jaundice: deep

14. • Edema: absent
• Dehydration: mild
• Koilonychia: absent
• Leuconychia: absent
• Clubbing: present
• Pulse: 88bpm
• BP: 110/70mmHg
• Resp rate: 16bpm

15. • Temperature: 99⁰F
• Lymph nodes: no palpable lymph nodes found
• Skin: scratch mark present all over body

16. Abdominal examination
• Inspection
• Shape: scaphoid
• Umbilicus: centrally placed, inverted
• Hair distribution: normal
• Visible swelling: absent
• Engorged vein: absent
• Scar mark: absent

17. • Superficial palpation: local temperature not raised. Mild tenderness
present in upper abdomen
• Deep palpation: there is a lump in epigastric region, 3*3 cm in size, ill
defined margin, irregular surface, firm in consistency, doesn’t move
with respiration.

18. • Organ palpation:
• there is a smooth surfaced cystic lump in right hypochondriac region
in 9th costal cartilage that moves with respiration- palpable
gallbladder.
• Liver: not enlarged
• Spleen: not palpable
• Kidneys: not palpable

19. • Percussion
• Fluid thrill: absent
• Shifting dullness: absent
• Auscultation
• Bowel sound: present
• Bruits: absent

20. • DRE
• Inspection: there is no fissure, fistula present
• Palpation: anal tone is normal, there is no growth found
• Proctoscopy: no bleeding seen, no growth seen
• Finger stained with stool upon withdrawal

21. Other systemic examination
• Respiratory system: no abnormality found
• Cardio vascular system: no abnormality found
• Nervous system: nothing abnormal

22. Salient feature
Mr Sohor Ali, a 55 years old smoker but nonalcoholic, non diabetic
normotensive male rickshapuller from Jhenaidah presented to me on
20/08/23 with the complaints of yellow discoloration of eyes and skin
for 3 months, Itching all over the body for 3 months, pain in upper
abdomen and weight loss for same duration. According to his
statement he was relatively well 3 months back. Then he noticed
yellow discoloration of his eye and skin which was increasing gradually
associated with itching, dark urine and pale stool. He also has dull
aching continuous non radiating pain in upper abdomen aggravated by
food and relieved by medication. He lost almost 40% of his weight
during this illness.

23. He has no history of vomiting, fever, hematemesis and melena. His past
medical history is insignificant and none of his family members are
suffering from this type of illness. He is non allergic and has no history
of blood transfusion. General examination revealed he is ill looking with
poor nutritional status. Mildly anemic, deeply icteric and mildly
dehydrated. No palpable lymph nodes present and his vitals are within
normal limits. Abdominal examination shows abdomen is scaphoid in
shape, umbilicus is centrally placed, inverted. Scratch mark present.
There is no visible swelling, peristalsis, engorged vein. Palpation
revealed mild tenderness in epigastrium. There is a mildly tender 3*3
cm, firm, irregular shaped, ill defined margined, intraabdominal lump

24. in epigastric region. There is palpable Gallbladder present. No
organomegaly found. Shifting dullness and fluid thrill are absent. DRE
finding is normal. Other systems revealed no abnormality.

25. Provisional diagnosis
• Obstructive jaundice due to carcinoma head of pancreas

26. Differential diagnosis
• Obstructive jaundice due to periampullary carcinoma
• Obstructive jaundice due to cholangiocarcinoma

27. Thank you