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A 50 year old man presents with jaundice and itching for 2 weeks. There was no history of fever, abdominal pain, loss of appetite, or loss of weight.

His C-reactive protein (CRP) is 15 mg/L, while a full blood count, renal functions, and serum electrolytes are all within normal parameters.

Select Relevant Investigations
Liver Function Tests

Performed

Total bilirubin: 25 mg/dL (<1.2)
Direct bilirubin: 10 mg/dL
ALP: 580 U/L (35-104)
GGT: 178 U/L (<39)
ALT, AST, INR: within normal parameters
Ultrasound Abdomen

Performed

The intrahepatic bile ducts are dilated, although the common bile duct is normal in size. The gallbladder is collapsed. The liver parenchyma and pancreas appear normal.
MRCP + MRI Abdomen

Performed

MRCP shows an irregular stricture at the biliary confluence, with symmetric dilatation of intrahepatic tree. MRI shows a 2×3cm mass in the same area, with T1 hypointensity and T2 hyperintensity. An enlarged retro-pancreatic lymph node is noted.
X-Ray Chest

Performed

The chest x-ray appears normal.

Select Relevant Management
ERCP + Biliary Stenting
Complete Resection of Tumor
Vitamin K
Antipruritics