Serum markers show elevated bilirubin, alkaline phosphatase, and CA 19-9 levels, suggesting possible pancreatic or biliary disease. The patient underwent diagnostic tests including Whipple's procedure, Puestow procedure for chronic pancreatitis, and palliative bypass procedures to treat probable pancreatic or biliary cancer or chronic pancreatitis based on the abnormal serum markers.

33. Investigation Value
Serum bilirubin 7.28 mg/dL (normal < 1.3 mg/dL)
Serum Alkaline phosphatase 685 U/L (normal 40-140 U/L)
Prothrombin time INR- 1.52 (17 Sec)
CA -19-9 1190 U/ml (normal <37 U/ml)
For diagnosis –

57. Procedure name Number
Whipple’s pancreaticoduodenectomy procedure 11
Puestow (lateral pancreaticojejunostomy) procedure ( for chronic
pancreatitis, pancreatic stone)
6
Pallaitive billio-pancreatic bypass (gastrojejunostomy with
choledocojejunostomy or cholecystojejunostomy or
choledochoduodenostomy)
7