Monday, October 20, 2008

Izzi

A patient comes in with acute right upper quadrant pain and a bit of nausea and vomiting. On exam, you note fever and jaundice. Labs show an elevated alkaline phosphatase and bilirubin. An ERCP cholangiogram is shown above. Luckily, the gastroenterologist labeled it for you.

Challenge: This syndrome is pretty nifty and was named after an Argentinean physician in 1948. What is it?

Image shown under fair use.

3 comments:

Alex said...

looks like an obstruction. i can't think of any argentinians - googled charcot, trousseau, vater, whipple.

Anonymous said...

Mirizzi's?

Cheated - had to look it up. But did suspect that it was an obstruction related problem form the lab values.

Craig Chen said...

nice - this was a popular pimp question in surgery.
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Izzi

This is Mirizzi syndrome, Type I, which describes a common hepatic duct obstruction due to extrinsic compression from an impacted stone in the cystic duct or Hartmann's pouch (from the infundibulum of the gallbladder). Even though the gallstone obstruction is in the cystic duct, the inflammation and mechnical impingement upon the common hepatic duct can cause jaundice and elevated liver enzymes. Type II Mirizzi syndrome refers to an erosion of the calculus from the cystic duct into the common hepatic duct forming a fistula. The U/S shows dilatation of the biliary system above the level of the stone at the cystic duct junction and a normal common bile duct caliber past the stone.

Sources: UpToDate; www.rcsed.ac.uk.