Differential Diagnosis for Middle-Aged Patient with Jaundice and History of Lap Chole
- Single most likely diagnosis
- A- Retained stone: This is the most probable cause of jaundice in a patient with a history of laparoscopic cholecystectomy (lap chole) 2 years ago. Retained stones in the common bile duct (CBD) can cause obstructive jaundice, and the patient's history of gallstone disease makes this a likely diagnosis.
- Other Likely diagnoses
- B- CBD stricture: A stricture in the common bile duct can also cause obstructive jaundice. This could be a complication of the previous lap chole surgery, and the patient's symptoms would be consistent with this diagnosis.
- D- Pancreatic head cancer: Although less common, pancreatic head cancer can cause obstructive jaundice by compressing the CBD. This diagnosis should be considered, especially if the patient has other symptoms such as weight loss or abdominal pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- C- Cholangiocarcinoma: This is a rare but deadly diagnosis that should not be missed. Cholangiocarcinoma is a cancer of the bile duct, and obstructive jaundice is a common presenting symptom. Although it is less likely than retained stones or CBD stricture, the consequences of missing this diagnosis are severe.
- Rare diagnoses
- Other rare causes of obstructive jaundice, such as primary sclerosing cholangitis, Caroli's disease, or parasitic infections (e.g., Clonorchis sinensis), could also be considered. However, these diagnoses are less likely and would require specific risk factors or laboratory findings to support them.