Published 18 February 2009, doi:10.1136/bmj.a3175
Cite this as: BMJ 2009;338:a3175

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Jaundice and malaise in a middle aged man

Helen J Fellows, specialist registrar in intensive care medicine1, Harry R Dalton, consultant gastroenterologist and honorary senior lecturer 2

1 Intensive Care Unit, Royal Devon and Exeter Hospital, Exeter EX2 5DW, 2 Royal Cornwall Hospital and Peninsular College of Medicine and Dentistry, Truro TR1 3LJ

Correspondence to: H R Dalton harry.dalton@rcht.cornwall.nhs.uk

The first 150 words of the full text of this article appear below.

A 52 year old man was referred to the jaundice hotline clinic by his general practitioner with symptoms of malaise and lethargy over one year and a seven day history of jaundice. Apart from a laparoscopic cholecystectomy eight years earlier, he had no other relevant medical history and took no drugs. On examination, he was jaundiced but had no other abnormal physical signs.

His laboratory findings were: bilirubin 135 µmol/l (normal range 3-17), alkaline phosphatase 971 U/l (3-110), alanine aminotransferase 154 U/l (3-35), albumin 35 g/l (35-45).

Ultrasound of the liver showed coarse echotexture and no intrahepatic biliary duct dilatation. Views of the common bile duct were poor owing to overlying bowel gas.

The patient went on to have endoscopic retrograde cholangiopancreatography as an outpatient (fig 1Go).


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  		Fig 1 Results of endoscopic retrograde cholangiopancreatography

 
1 What is the diagnosis?
2 What further investigations should he have?
3 What treatment . . . [Full text of this article]


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