A 78 year old lady with skin manifestations and jaundice

I am Saranya ,a final year MBBS student.

Greetings to all my readers;

This is an elog documenting the patients that I witness during my Clinical Postings to enforce a greater patient centered learning .

 

 DEIDENTIFICATION : 

The privacy of the patient is being entirely conserved. No identifiers shall be revealed through out the piece of work whatsoever.

Introduction :

Chief Complaints:

The patient being discussed here is a 78 year old lady hailing from the eastern part of India , who presented with the complaints of itching all over her body since 6 months and jaundice since 15 days.

History of presenting illness : 

The patient was apparently asymptomatic 6 months ago when she experienced itching all over her body which was insidious in onset and kept increasing gradually , It began on the anterior aspect of the forearm and then kept spreading.

It is also understood that since the itching over her skin began, over the time ,her skin became darker than it was previously.

It was also noted by her family that her appetite had become less and that she had lost some weight as well.

Due to all these findings, 15 days back,  on consultation with the local physician, some blood works were done and the Liver function test values were found to be deranged.

Daily Routine : 

Even at the age of 78 years , the patient as described by her son is extremely active throughout the day and prefers herself to be self sufficient in all her daily chores.

She gets up in the morning at 5 am ,freshens up, and does pranayaam for 1 hour , next she reads some Holy scriptures for 1 hour , after which she consumes a cup of tea , 

She again engages in Puja related work for another 2 hours after that , and then at around 10 o'clock has breakfast .

The time from breakfast to lunch at around 1.00 pm is spent differently on different days, on sp.e days she reads the newspaper, or engages in conversations with her neighbours,in some other days she goes out and completes some small chores nearby. 

After lunch she takes some rest .

In the evening she spends time talking to her family, or watches the television

Has dinner at 9.00pm and sleeps by 10.00 pm

Note : She is a hypertensive on medications since 30 years.

Notes about the patient : 

Ultrasound Report : 

BLOOD INVESTIGATIONS: 

Grossly deranged liver function test panel : 

Ct scan report : 

Impression : Periampullary mass

? Periampullary Carcinoma

Enlarged lymph nodes around 2nd part of duodenum

Porcelain Gall bladder.