Differential Diagnosis for New-Onset Obstructive Jaundice and Abdominal Pain
Single Most Likely Diagnosis
- Pancreatic Cancer: The patient's presentation with obstructive jaundice, abdominal pain, and markedly elevated liver enzymes and bilirubin, along with the imaging findings of intra and extrahepatic duct dilatation and a dilated CBD tapering abruptly in the pancreatic head, is highly suggestive of a pancreatic malignancy. The suspected exophytic isoenhancing focus in the lateral aspect of the uncinate process further supports this diagnosis.
Other Likely Diagnoses
- Cholangiocarcinoma: This is another possible cause of obstructive jaundice and abdominal pain, especially given the high-grade CBD stricture. Cholangiocarcinoma can present similarly to pancreatic cancer and would need to be considered in the differential diagnosis.
- Ampullary Cancer: Located at the junction of the pancreatic and bile ducts, ampullary cancer can cause obstructive jaundice and abdominal pain. Although less common than pancreatic cancer, it is a possible diagnosis given the patient's symptoms and imaging findings.
- Pancreatic Neuroendocrine Tumor: Although less likely than pancreatic cancer, a pancreatic neuroendocrine tumor could cause obstructive jaundice and abdominal pain, especially if it is located in the pancreatic head.
Do Not Miss Diagnoses
- Gallbladder Cancer: Although less common, gallbladder cancer can cause obstructive jaundice and abdominal pain. It is essential to consider this diagnosis to avoid missing a potentially curable malignancy.
- Hepatocellular Carcinoma with Bile Duct Invasion: Although the patient's liver function tests are not suggestive of cirrhosis, hepatocellular carcinoma can cause bile duct obstruction. This diagnosis should be considered, especially if the patient has risk factors for liver disease.
Rare Diagnoses
- Intraductal Papillary Mucinous Neoplasm (IPMN): IPMN is a rare tumor of the pancreatic ducts that can cause obstructive jaundice. Although less likely, it should be considered in the differential diagnosis, especially if other diagnoses are ruled out.
- Lymphoma: Lymphoma can cause obstructive jaundice and abdominal pain, although it is a rare cause of these symptoms. It should be considered in the differential diagnosis, especially if the patient has a history of lymphoma or immunosuppression.
- Metastatic Disease to the Pancreas: Metastatic disease to the pancreas can cause obstructive jaundice and abdominal pain. Although rare, it should be considered in the differential diagnosis, especially if the patient has a history of cancer.