Transcript yellowish discoloration of the skin

Matias; Maulion; Medenilla; Medina; Medina; Mejino;
Melgarejo; Mendoza, Alvin, Diana and Donn

K.F.
 80 year old
 female

Informant: patient

Chief Complaint:
yellowish discoloration of the skin

2 months PTC
gradual loss of weight
decrease in appetite
dull abdominal pain in the epigastric area
No consult was done, no medications
taken

1 week PTC
yellowish discoloration of skin & sclerae
progression of the abdominal pain
acholic stools
Persistence prompted present consultation.











BP 140/90, PR 89 bpm, RR 20 cpm
Temp 36.5 °C
Warm moist skin, (+) jaundice
Pale palpebral conjunctivae, icteric sclerae
No naso-aural discharge
Moist buccal mucosa, yellowish frenulum
Supple neck, no palpable cervical lymph nodes
Flabby, soft and non-tender abdomen
Normoactive bowel sounds
Pulses full and equal
No cyanosis, no edema
SALIENT FEATURES








80- year old
Female
Gradual weight loss
Decrease in appetite
Dull abdominal pain in the epigastric area, which
later progressed
Yellowish discoloration of the skin and sclerae
Yellowish frenulum
Acholic stools
Choledocholithiasis





Presence of a gallstone in the common bile duct
The stone may consist of bile pigments or
calcium and cholesterol salts
About 15% of people with gallstones will develop
stones in the common bile duct
Risk factor: a previous medical history of
gallstones
However, choledocholithiasis can occur in
people who have had their gallbladder removed.
Clinical Manifestations
 Abdominal
pain
- sharp, cramping, or dull
- may spread to the back and
subscapular area
- get worse after eating fatty or greasy
foods
- may occur within minutes of a meal
Clinical Manifestations
 Fever
 Loss
of appetite
 Jaundice
 Nausea
 Vomiting
Ultrasound
Abdominal ultrasound scans show a mildly dilated common bile duct measuring 8 mm in
diameter (arrow). An echogenic calculus with acoustic shadowing is visible in the distal portion
of the common bile duct (arrow). There is no intrahepatic biliary dilatation. The gallbladder
appears contracted (arrow). These findings are consistent with choledocholithiasis resulting in
early or incomplete biliary obstruction.
Ultrasound
ultrasound findings
- dilated common bile
duct (cbd) with small stone
located distally (arrow).

posterior acoustic
shadowing (arrowhead)
CT Scan
Common bile duct stone
- target sign
On contrast-enhanced helical CT
scan, choledocholithiasis is
represented as central density
(arrowhead) surrounded by
hypoattenuating ampulla of
Vater (arrow).
In this particular scan, stone is
seen as heterogeneous with
center showing lower density.
CT Scan
Stone in distal common bile duct
- rim sign
Faint rim of increased density
(arrow) along peripheral margin
of low-density calculus
CT Scan
Common bile duct stone
- crescent and target signs
stone (arrow) completely
surrounded by bile