Mellow Yellow: Diagnosis and Management of Multifactorial Postoperative Jaundice

Excerpt

A 55-year-old Hispanic man, with a prior history of gastroesophageal reflux disease, fatty liver, and cholelithiasis, was evaluated in the emergency department with complaints of severe right upper quadrant pain that was triggered by food but not associated with any other gastrointestinal symptoms. One month prior, he had been evaluated by his primary care physician due to similar, but less severe and self-limited pain, undergoing an abdominal ultrasound that had revealed cholelithiasis without evidence of cholecystitis. At the time of admission to the hospital, he was afebrile and mildly icteric. His abdominal examination was notable for epigastric tenderness, without rebound or guarding. Laboratory tests were notable for a leukocytosis (17.3 K/μL) and mildly elevated serum liver enzyme concentrations (ALT 69 IU/L; bilirubin 3.2 mg/dL) (Figs. 1, 2). A repeat abdominal ultrasound was reported as showing no evidence of gallbladder wall thickening or acute changes of cholecystitis, but a dilated common bile duct (CBD) at 10.7 mm.

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