(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Biliary obstruction refers to jaundice caused by obstruction of the biliary tract due to various etiologies, as in the case of this patient, an 80-year-old man in not too good physical condition, who presented with generalized yellowing as well as yellowing of urine upon admission to the hospital. Liver function tests were performed on the patient, and bilirubin and transaminases were found to be significantly elevated, and the patient was finally diagnosed with bile duct obstruction. Through surgical treatment, the patient’s jaundice was successfully resolved with good results.
[Basic information] Male, 80 years old
Disease Type】Bile Duct Obstruction
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (biliary stenting)
Treatment Period】1 week in hospital
Effectiveness】The jaundice completely disappeared and the general condition improved
I. Initial consultation
An elderly grandfather, aged about 80, came to the clinic today. With the development of an aging population, there will be more and more such elderly patients. The patient mainly presented with yellowing of the whole body and yellow urine, the same color as strong tea water. At that time, we considered that the patient might have obstructive jaundice, and the most common cause of obstruction was bile duct stones or bile duct tumors. Liver function tests were performed on the patient, and bilirubin and transaminases were found to be significantly elevated, also supporting obstructive jaundice. Next, a routine ultrasound examination was performed and found that there was an occupancy at the end of the common bile duct, not a stone. The patient was now more jaundiced and eating poorly, so we admitted the patient to the hospital with a preliminary diagnosis of bile duct obstruction.
II. Treatment history
In order to find out the cause of bile duct obstruction, we performed an intensive CT examination for the patient, and the results showed that there was a significant enhancement of the common bile duct end and CA199 was also significantly increased. Considering that the old man is now very old and his general physical condition is not too good, the risk of doing this surgery is relatively large. After explaining the current condition with the patient’s family, the patient’s family also expressed that they did not want to take such a big risk to do the surgery and wanted to take conservative treatment. After discussion and communication, it was decided to use the form of stenting, where a stent is placed in the bile duct under cholangiography to open up the bile duct and restore normal bile drainage, which can gradually improve the jaundice, and the patient’s eating can also improve soon after the jaundice improves. The patient and his family underwent biliary stenting, and the operation went well.
III. Treatment effect
Biliary stenting is a local anesthesia procedure, which is very less invasive to the patient, so the patient’s recovery after the procedure is very fast. The patient’s jaundice decreased rapidly, and the bilirubin level dropped from 300+ to normal very quickly. As the bilirubin decreased and the jaundice was reduced, the patient’s diet gradually improved and the patient’s mental state also gradually improved. The patient and his family were very satisfied with the treatment effect.
IV. Precautions
I was particularly pleased to see that the patient’s condition gradually improved, but since the patient’s resistance is relatively poor and his body is weak, he should pay attention to rest and avoid catching cold. The daily diet should gradually increase nutrition, and you can eat more lean meat, fish, milk and other highly nutritious food. After the patient is discharged from the hospital, the change of liver function should be reviewed regularly, because the patient’s biliary stent is placed on the tumor, the growth of the tumor may also lead to the obstruction of the stent, so the patient’s body reaction should be closely observed, because the stent may lead to this intestinal fluid reflux into the bile duct causing biliary system infection and fever, etc. If the above uncomfortable symptoms occur, the patient should seek medical attention in time.
V. Personal insight
The incidence of bile duct cancer is increasing, which is related to our living habits, environmental factors and genetic factors. The most common symptom of cholangiocarcinoma is jaundice. If jaundice and right upper abdominal discomfort occur, you should seek medical consultation in time. With the development of aging population, there are more and more patients of advanced age. As in the patient of this case, combined underlying diseases such as many, and poor physical condition, cannot receive radical surgery. However, in order to achieve a better quality of life and increase survival time, we can also take a conservative treatment approach to first resolve the biliary obstruction, and the main treatment modalities currently include stenting or external drainage, and then comprehensive anti-tumor therapy after the jaundice is lifted, which is also relatively effective.