The Gorgas Courses in Clinical Tropical Medicine

Selected Cases Seen by 2009 Course Participants

History:  45 yo female admitted with a two-month history of epigastric pain with progressive onset of jaundice, dark urine and colorless stools over the next two weeks.  No fever, weight loss, no IV drug use, no alcoholism, or new sexual partners.  No previous episodes of abdominal pain or jaundice.

Epidemiology:  From Chincha on the south coast of Lima Department.  Lives near a slaughterhouse, and always had dogs.  No ingestion of aquatic plants.

Physical Examination:  Afebrile, markedly icteric, painful grossly enlarged and irregular spleen.  Exam otherwise normal.

Laboratory Examination:  Hct. 42.  WBC 7400 (54% PMNs, 2% eos); total bilirubin 8. 8 mg/dl N <1); 7.4 direct; alkaline phosphatase 740 (N <126); ALT 155 (N <40); AST 211 (N <40); amylase 65 (N <20); GGT 222 (N <73); alfafetoprotein, CEA, CA 125 and CA19 all negative.  ERCP [Image A] disclosed stenosis of the upper third segment of the common bile duct and mild dilatation of the intrahepatic bile ducts with no leakage of contrast outside the duct.  A CT scan after stent placement is shown in Image B.  Chest x-ray was normal.  A diagnostic test was performed.

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