GI Jaundice Cases.pptx Case scenarios on jaundice

Case Scenarios on different causes of jaundice for review in clinical semiology.

1. Case 1 (Clinical Picture) Clinical Vignette: 42-year-old woman with sudden severe RUQ pain after fatty meal Pain radiates to right shoulder Associated with fever, nausea, vomiting Exam Findings: Febrile, positive Murphy’s sign Localized RUQ tenderness, mild guarding

2. Case 1 (Diagnostics) Laboratory Results: WBC: 14,000/µL LFTs: near normal or mildly ↑ ALP Imaging: Ultrasound: distended gallbladder, thickened wall, gallstones, pericholecystic fluid What is the suspected diagnosis?

3. Case 2 (Clinical Picture) Clinical Vignette: 55-year-old man with intermittent colicky RUQ pain for 6 months Pain after meals, lasts 30–60 minutes No fever Exam Findings: Non-tender abdomen between attacks Scleral icterus during pain episodes

4. Case 2 (Diagnostics) Laboratory Results: Total bilirubin: 4.2 mg/dL (mostly conjugated) ALP and GGT: elevated Imaging: Ultrasound: gallstones + stone in CBD, biliary dilation What is the suspected diagnosis?

5. Case 3 (Clinical Picture) Clinical Vignette: 23-year-old student with fatigue, anorexia, nausea, dark urine for 1 week Low-grade fever, malaise Exam Findings: Jaundice with tender hepatomegaly No splenomegaly or ascites

6. Case 3 (Diagnostics) Laboratory Results: ALT: 1450 U/L, AST: 1300 U/L Total bilirubin: 5.8 mg/dL (mixed) Serology: HBsAg positive, anti- HBc IgM positive Task for Students: What is the suspected diagnosis?

7. Case 4 (Clinical Picture) Clinical Vignette: 38-year-old man with sudden severe epigastric pain radiating to back History of binge alcohol use Exam Findings: Pain relieved by leaning forward Nausea, vomiting Epigastric tenderness, mild distension, low-grade fever

8. Case 4 (Diagnostics) Laboratory Results: - Serum amylase: 950 U/L - Serum lipase: 1800 U/L Imaging: Ultrasound: edematous pancreas, no gallstones What is the suspected diagnosis?

9. Case 5 (Clinical Picture) Clinical Vignette: 67-year-old man with progressive painless jaundice (2 months) Dark urine, pale stools, pruritus Significant weight loss Exam Findings: Cachexia, palpable non-tender gallbladder (Courvoisier sign)

10. Case 5 (Diagnostics) Laboratory Results: - Bilirubin: 15.2 mg/dL (mostly conjugated) - ALP: markedly elevated Imaging: - CT: hypodense mass in pancreatic head obstructing bile duct What is the suspected diagnosis?

11. Case 6 (Clinical Picture) Clinical Vignette: 52-year-old man with long-standing alcohol use Progressive abdominal swelling, leg edema, fatigue History of hematemesis 2 weeks ago Exam Findings: Jaundice, spider angiomas, palmar erythema Ascites, splenomegaly, shifting dullness, bilateral ankle edema

12. Case 6 (Diagnostics) Laboratory Results: Total bilirubin: 6.0 mg/dL ALT/AST: mild ↑, AST > ALT Albumin: 2.3 g/dL (low) INR: 1.8 (prolonged) Imaging: Ultrasound: nodular liver, ascites, splenomegaly What is the suspected diagnosis?