Editor's quiz: GI snapshot
Obstructive jaundice following a myocardial infarct
1 Heart of England NHS Trust, Birmingham, UK
2 Walsgrave Hospital, Coventry, UK
Correspondence to:
Dr Shuvro H Roy-Choudhury, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK; shuvro@supanet.com
| The first 150 words of the full text of this article appear below. |
Clinical presentation
A 70-year-old man presented with a non-ST elevation myocardial infarction. Physical examination, ECG and blood tests including liver function tests were normal. Treatment with aspirin, clopidrogel and enoxaparin was commenced.
The chest pain resolved. However, from the third day there was an obstructive pattern in his liver function tests without abdominal symptoms (bilirubin 238 mmol/l, alkaline phosphatase 480 IU/ml, aspartame transaminase 156 IU/ml). This derangement coincided with a decrease in haemoglobin by 3 g/l. Given a recent diagnosis of prostatic carcinoma, a differential diagnosis of pancreatic head mass, possibly of metastatic or primary malignant aetiology, causing obstructive jaundice was made on initial imaging.
Multi-slice computed tomography (CT) illustrated calcification within the pancreatic head, consistent with chronic pancreatitis and a 6.5 cm mass was demonstrated within the pancreatic head intimately related to the gastroduodenal artery, with similar enhancement to that in the aorta (fig 1).
Figure 1 Contrast enhanced multi-slice abdominal | |||||||||
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Gut 2008 57: 187.[Extract] [Full Text] [PDF]
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