A 65-year-old woman presents with a 5-week history of yellow skin and sclera, anorexia, and epigastric pain. Her past medical history is significant for insulin-dependent diabetes mellitus. She smoked one pack of cigarettes a day for the past 20 years. Physical examination reveals jaundice and a palpable gallbladder. Laboratory studies show a serum bilirubin level of 10 mg/dL, mostly in the conjugated form, and an elevated alkaline phosphatase (260 U/L). A CT scan of the abdomen discloses a mass in the head of the pancreas and multiple nodules in the liver measuring up to 3 cm. Which of the following is the most likely cause of jaundice in this patient?
Pancreatic adenocarcinomas often cause obstruction of the common bile duct due to the proximity of the duct to the head of the pancreas. Painless jaundice is a frequent initial symptom of pancreatic cancer. Dilation of the gallbladder in this setting is termed Courvoisier sign. Cirrhosis (choice B) is a late complication of extrahepatic biliary obstruction.Diagnosis: Pancreatic adenocarcinoma
Cholelithiasis
Cirrhosis
Extrahepatic biliary obstruction
Hemolysis
Pancreas