1. A 60-year-old male presented with yellowish discoloration of the eye, itching all over the body, pale stools, loss of appetite, and weight loss. 2. Obstructive jaundice and periampullary carcinoma were suspected given his age, painless progressive jaundice, pruritis, pale stools, and weight loss. 3. Key clinical features of obstructive jaundice include jaundice, intense pruritis, pale stools, loss of appetite and weight in patients typically aged 50-70 years.

1. CASE
60 year old male presents with yellowish
discolouration of the eye, itching all over the
body and pale stools. He also complains of loss
of appetite and weight loss.

2. OBSTRUCTIVE JAUNDICE

3. PERIAMPULLARY CARCINOMA ?
• Old age
• Painless progressive jaundice associated with
pruritis
• Pale stools
• Weight loss and loss of appetite

4. CLINICAL FEATURES
• AGE : 50-70 Years
• Equally common in both the sexes.
• Short duration of symptoms.
• JAUNDICE
• intense PRURITIS
• PAIN is relatively rare
• Pale coloured / Silvery stools
• Loss of appetite and weight.

5. • Left supraclavicular nodes palpable
• Gall bladder may be palpable, non tender,
soft, globular, smooth, moves with
respiration, mobile horizontally, dull on
percussion.
• Liver is enlarged, smooth, firm, nontender,
• splenomegaly due to splenic vein thrombosis.

6. INVESTIGATIONS
• Hb
• TC,DC
• Prothrombin time is increased.
• Urine is negative for urobilinogen, bile salts,bile
pigments.
• Serum alkaline phosphatase >500 U
• Serum and direct bilirubin is increased.
• Serum albumin is decreased with altered A:G
ratio.

7. • Abdominal ultrasound: gall bladder, liver,
pancreas, growth, stones, CBD size, lymph
node status, portal vein, ascites.
• endosonography

8. • CT scan to assess operability. spiral ct

9. • Endoscopy + biopsy
• Barium meal : inverted 3 sign

10. • Endoscopic retograde cholangio-
pancreatography : irregular filling defect,
double duct sign,parenchymal filling,
scrambled egg

11. • Percutaneous transhepatic cholangiography.

12. • MRI : to visualize the biliary tree.

13. • Diagnostic laproscopy : peritoneal deposits
• CA 19-9 > 37U/ml.