(Even though the case is titled Darth Vater, it does not have to do with the ampulla itself, I just liked the title).
A 50 year old man with known untreated choledochal cysts presents with subjective fever, weight loss, and pruritis. The onset is unclear; it has been gradual over the last few months. He also has a dull ache in the right upper quadrant of the abdomen. You notice he is clearly jaundiced and when you ask, you find out he has clay-colored stools and dark urine. The rest of your physical exam is notable for hepatomegaly and a palpable gallbladder.
Laboratory results show an elevated total and direct bilirubin, alkaline phosphatase, 5'-nucleosidase, and gamma-glutamyltransferase. AST, ALT, and coags are normal. Here's a CT:
This is the finding on ERCP, showing common bile duct stricture and dilation of the proximal common bile duct:
Challenge: What's your diagnosis?
1. What "sign" is the palpable gallbladder?
First image shown under GNU Free Documentation License, second image is in the public domain.