Uncontrollable itching – part II

As we heard the history we stopped, prior to hearing the exam and labs, and developed a differential diagnosis.  With the combination of itching, probable jaundice and pale stools we assume either intrahepatic or extrahepatic obstruction.  Our differential diagnosis with commentary:   Primary biliary cirrhosis – much more common in women then men – but does often present at this age with uncontrollable itching Primary sclerosing cholangitis – no history of ulcerative colitis or diarrhea symptoms, but still possible Gallstone – not all common duct stones cause pain Cholangiocarcinoma – could clearly cause extrahepatic obstruction Pancreatic cancer – probably the number one consideration from history alone. Physical exam – positive Murphy’s sign Labs: CBC and basic metabolic panel unremarkable Test Value AST 163 ALT 220 Alk phos 604 T Bili 5.9 GGT 1500 Helical CT ordered – will report tomorrow What is your best guess?  Have we left anything out of the differential?
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs