Welcome back to Mystery Case Monday! We will be posting a hypothetical case every week to get our pre-health students thinking about various clinical issues and the anatomical/physiological causes that underlie them. Join us in the comments section to share your insights and tentative diagnoses, then check back on Friday to read about the diagnosis and recommended treatments of these cases.
This week's hypothetical patient is a Vietnam War veteran who was admitted to the hospital after experiencing abdominal pain, fever, nausea, and episodes of vomiting. His urine is a dark color and his stools are light, almost white, in color. He reports that he has been losing weight unintentionally lately and that he has been experiencing itching sensations. He appears to be jaundiced upon admittance. His physician had seen a similar case with a Vietnam veteran a few years ago when she worked in a different hospital. She asked her patient if he had ever eaten raw or under-cooked fish from rivers in Vietnam while he had served during the war. He stated that he had. She then ordered a few blood tests to check liver function and for antibodies to a suspected type of pathogen. She also ordered a CT scan, an MRI, and a MRCP. After getting the results back, the physician talked with her patient about options for treating a cholangiocarcinoma that had formed.
Thought Questions:
This week's hypothetical patient is a Vietnam War veteran who was admitted to the hospital after experiencing abdominal pain, fever, nausea, and episodes of vomiting. His urine is a dark color and his stools are light, almost white, in color. He reports that he has been losing weight unintentionally lately and that he has been experiencing itching sensations. He appears to be jaundiced upon admittance. His physician had seen a similar case with a Vietnam veteran a few years ago when she worked in a different hospital. She asked her patient if he had ever eaten raw or under-cooked fish from rivers in Vietnam while he had served during the war. He stated that he had. She then ordered a few blood tests to check liver function and for antibodies to a suspected type of pathogen. She also ordered a CT scan, an MRI, and a MRCP. After getting the results back, the physician talked with her patient about options for treating a cholangiocarcinoma that had formed.Thought Questions:
What is the most likely underlying cause for the development of the patient's cholangiocarcinoma?
What was the physician looking for when she ordered the tests that she ordered for her patient?
Why are MRCPs being used more frequently than ERCPs for these kinds of cases?
What are the treatment options for patients with this condition?
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