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Jaundice with positive bilirubin and urobilinogen in urine.

Please help.  My mom suddenly had jaundiced eyes and went immediately for check up. Her urine was hazy with bilirubin and urobilinogen positive and her CBC showed elevated lymphocytes.  She was only tested for HbSag and came out non reactive. Her AST was at 40u/l (reference 0-31) and ALT was 35 u/l(reference 0-34).  What could possibly be happening to her, she denied any other symptoms.

Please help.  Thank you!


This discussion is related to Hole in sotmach repair .
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Avatar universal
These worms have been elusive by migrating via the CBD. So the exploratory procedures aren't always successful the first time. I would push for more frequent, short-term ultrasounds to see if the parasite can be detected. And another follow-up soon for an extraction and to see if there is any residual scarring that maybe causing some obstruction. Given that the doctors already know she has biliary ascariasis, the chances that she is also dealing with another type of biliary disease is very unlikely.

Hope they are successful this time, take care.
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Hi my mom was diagnosed with biliary ascariasis and had undergone lap chole with CBD exploration.  Up to this time, 2 weeks postop, her t-tube have been sraining up to 900ml per fay.  Cholangiogram suggested obstruction as the dye is unable to be pushed in.  What do you think is the possible cause, CT scan, ultrasound never shown any growth in her ampulla of vater which I think is the possible location of the obstruction.  By the way she manifested painless jaundice prior to her diagnosis and surgery.
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Avatar universal
Is it possible that a tumor is misdiagnosed as stones in CT? The findings says hypodense foci manifesting a hyperdense rim and read as partially calcified stones.

What really worries me a lot is the painless jaundice :(.
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Avatar universal
I agree, being absolutely through on the followup is a good idea. And looking beyond the already confirmed diagnosis (lithiasis) for other co-factor(s) will be easier with an additional set of eyes involved.

Also, imaging with MRI/MRCP technology would be a great addition to the data pool - (1) different imaging modality vs CT - (2) the MRI sequences complement the MRCP sequences in that, the former, focuses on the tissues and, the latter, focuses on the static fluid within.

In addition, hepatobiliary malignancies can sometimes be flagged with a couple of blood serum tumor markers: CEA and CA19-9. However, the doctors have to be careful due to the low specificities involved, some benign cholestatic conditions can cause elevations too.

Hopefully this will prove to be negative. The likelihood of these types of malignancies is quite low.
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Avatar universal
My deepest appreciation for all the responses.  According to the US, the common duct is dilated at 15.9mm and the CT scan showed 2 stones of 0.8 and 0.7 cm in size.  She went to another doctor for second opinion and it seems that they are not satisfied with the CT scan impression of stones blocking the ducts.  I am thinking that it is due to the fact that she is having painless jaundice which usually suggests malignancy.  Is there really a high possiblity of malignancy?

Thank you!
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Avatar universal
The small stones do fit the data so far pretty well. Hopefully they can get them resolved shortly and then you will be able to see if your mother returns to normal or not. The lack of pain also fits the fact that the stones were small, low amount of impedence and mild ductule dialation.

I would try to get her doctor to do a careful follow-up on her for the next 6 months or so. Blood work every month or so (maybe even bi-weekly). And a final MRI or CT in six months, just to be sure. Given the infection and lithiasis issues, I'd think he'd be doing this anyway. Hope it all works out well, take care.
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Avatar universal
Thanks fntn for the responses.

My mother had CT scan of the abdomen and the reult showed two stones in the distal common bile duct.  But I am still quite nervous as she never complained of pain except the feeling of bloatedness and she is jaundiced.  Is there a possibility that the CT Scan is missing something out?
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Avatar universal
Thanks fntn for the responses.

My mother had CT scan of the abdomen and the reult showed two stones in the distal common bile duct.  But I am still quite nervous as she never complained of pain except the feeling of bloatedness and she is jaundiced.  Is there a possibility that the CT Scan is missing something out?
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Avatar universal
It seems that she is dealing with both kidney and hepatobiliary issues. Do her doctors suspect that the infestation is the reason for both?

Bilirubin only becomes water-soluble (and excreted by the kidneys) after it has been processed by the liver. So this, and the dilated bile ducts, point to an bile flow obstruction(s) downstream of her liver. Her liver enzymes are not elevated which means that the obstruction isn't total. Ascaris should certainly be in the differential diagnosis as it can invade the bile ducts very easily. Hopefully some new imaging work will lead to the final diagnosis and to a successful treatment program.
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Avatar universal
Urobilinogen showed 3+ and Urine bilirubin showed 2+. They did not put any numerical value on it.
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Avatar universal
They did not test her for bilirubin. Her urine analysis showed casts and leukocyts.  They did an ultrasound though and found a possible ascaris in her gall bladder around 3.5cm in length. Her intrahepatic duct was dilated as well as her common bile duct (around 15.9) and the sonologist suggested a CT scan to rule out distal common bile duct obstruction. Is it possible that the dilated ducts was due to the ascaris?
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Avatar universal
You mention her urine being hazy. Did they do a micro-analysis as well? The haziness might be due to the color change but just make sure they check for any subtle kidney issues with the micro-analysis: casts, etc.

What are her liver's: alp, bilirubin (total and direct) levels? Her urine should show some urobilinogen but elevations are an issue, do you know how high the level was?
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