Abstract
A 68-year-old man presents to the emergency department complaining of fatigue and intermittent vague abdominal pain. He denies nausea or vomiting, but “does not have much of an appetite these days.” He reports having lost almost 20 lbs in the past 2 months. He was recently diagnosed with type 2 diabetes, but he has no other medical problems and no previous surgeries. His stools have become lighter in color and his urine is much darker than before. His social history is negative for alcohol use, but he has a 50+ pack-year smoking history before quitting last year. He has no significant family history. On exam, he has a yellow hue to his eyes and tongue, along with scratch marks on his skin. A non-tender mass is palpated in the right upper quadrant (RUQ) of the abdomen. Laboratory testing reveals total and direct bilirubin of 18 mg/dl (normal 0.2–1.3 mg/dl) and 9.2 mg/dl (<0.3 mg/dl), respectively, and alkaline phosphatase elevated at 215 μ/L (33–131 μ/L). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are mildly elevated. CA 19-9 and CEA levels are normal.
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Wu, J.X., de Virgilio, C., Lin, M.Y.C., Hari, D.M. (2020). New Onset of Painless Jaundice. In: de Virgilio, C., Grigorian, A. (eds) Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-05387-1_21
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DOI: https://doi.org/10.1007/978-3-030-05387-1_21
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