Patient Asia Bibi Cholangiocarcinoma.pptx

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1. Dr Siddiqa Akram PGR West Surgical ward King Edward Medical University West Surgical Ward Mayo Hospital Cholangiocarcinoma

2. BIODATA Patient name:Asia Bibi Age: 45 years/ F Resident of: Lahore Mother of 3 children

3. HISTORY Presented with pain in epigastrium and right hypochondrium for last 9 months.Pain was started after every meal and was associated with nausea and indigestion. Patient also has history of yellow discoloration of eyes and skin and whole body itching for last 9 months also. Patient is hepatitis C +ve Patient is normotensive and normoglycemic. Patient has history of asthma in past . No significant past surgical history

4. EXAMINATION : On general physical examination patient was thin lean and deeply jaundiced. There was rash and itch marks all over the Body On abdominal examination , abdomen was soft but tender at right hypochondriac region and epigastrium. No viscera palpable. No lymphadenopathy Patient belongs to ECOG score 1 category.

5. INVESTIGATIONS

6. Ultrasonography An I'll defined heterozygous lesion measuring 3.6* 2.5 cm is noted causing complete luminal obliteration of distal CBD resulting gross retrograde IHBC dilatation concerning for cholangiocarcinoma. CBD size .16 mm

7. MRCP 5 August 2024 Gall bladder shows signal void suggestive of cholelithiasis There is moderate dilatation of intra and extra hepatic biliary channels. Right hepatic duct measures 9 mm and Left hepatic duct measures 10 mm. Cystic duct measures 10 mm Extra hepatic CBD measures.1.8 mm There is sudden cut off of CBD in it's extra hepatic part mostly likely due to choledocholithiasis with no evidence of signal void in visualized course of CBD

8. ERCP 7 August 2024 Normal looking ampula ,selective CBD cannulation achieved Cholangiogram showed grossly dilated CBD and intrahepatic biliary channels with a stricture at Distal CBD.no.negative shadow.Sphinterotomy done. CBD swept with stone extraction balloon, no stone retrieved . Brushing cytology from stricture done and saved for cytology. Stricture dilated with 10 Fr Soehendra dilator . 80mm*8vm uncovered metallic stent placed across CBD stricture,free flow of bile seen. Diagnosis : Distal Cholangiocarcinoma

9. CT Abdomen with contrast with hepato biliary protocol Reports are awaited.

10. Labs Bilirubin Trend: 11.1 mg/ dl >16 mg/ dl> 0.2 mg/dl Alkaline phosphatase 859IU/ l > 919 IU / l > 115 IU/ l CA 19-9 level s 909.6 u/ ml

11. Plan: