Painless Jaundice....

Was reviewing some charts to sign earlier, and signed one from a patient I saw recently. Middle Aged, slender female presents with painless jaundice. Finally came in, because her daughter noted that she was "pretty yellow". My heart sunk as I read the complaint, cause I know the most likely cause before I even enter the room. I go into see her, and examine her. Non smoker, no abdominal pain to palpation, no distention, significant dermal jaundice, and scleral icterus. Her daughter and her begin to ask about potential causes, and I explain that the most likely cause is an obstructive process of the biliary duct system, and that generally, if it is painless, that it has been a slow progressive process. We discuss bilirubin, and the cycle bilirubin goes through in the body, albeit in laymens terms. They ask what the causes can be, and I explain that the most likely cause is malignancy. I also explain, that it is not the ONLY possibility, that occasionally, a chronic pancreatitis can cause these symptoms, and I have seen one patient with painless jaundice that ended up having Hepatitis A. I explain the need for the CT scan.....


5cm mass in the pacreatic head. UGH. I hate these conversations. I go into the room, close the door, and sit down with the patient for awhile. I explain the findings, explain the most likely cause, but that it would need to be confirmed with an ERCP. I explain that they can hopefully place a stent when they perform the ERCP, and this should definitely improve the jaundice. I call her primary at home, even though it is the weekend, and she appreciates the call. The patient leaves, and even though I know that it is part of the job, I tell the RN to give me five minutes, and I go back, sit in the office, and take a deep breath.

Life sucks somedays.