The Clinical Problem Solvers Episode 352 – RLR – The Wrong Context
Sep 3, 2024
Dive into a captivating discussion about a patient facing jaundice and the diagnostic hurdles it presents. The hosts analyze a complex case of abdominal pain coupled with weight loss, unraveling its gastrointestinal implications. They explore the vital role of imaging and careful examination in making accurate diagnoses. Additionally, they tackle the interpretation of abnormal sodium levels in pancreatic cancer contexts. With a blend of humor and personal anecdotes, the hosts share insights that intertwine friendship with medical prowess.
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Jaundice Narrows The Diagnostic Focus
- Jaundice converts the diagnostic problem into hyperbilirubinemia and narrows the focus quickly.
- Distinguish direct versus indirect bilirubin early to guide liver vs biliary localization.
Get Contrast CT First, Then MRCP If Needed
- Use contrast CT as the first-line imaging for subacute abdominal pain with suspected hepatobiliary disease.
- If CT is nondiagnostic, proceed to MRCP for detailed biliary visualization.
Lab Pattern Suggests Extrahepatic Obstruction
- A disproportionately high bilirubin with only mild transaminase/ALP elevation suggests extrahepatic obstruction.
- Combine labs with imaging to decide between intrahepatic versus extrahepatic causes.