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To the Editor:—
Icterus due to malignant disease in the region of the head of the pancreas and distal common bile duct all too often heralds the presence of an incurable condition. At what stage the lesion will produce regurgitation jaundice is of clinical significance and depends for the most part on the hydrodynamics of the biliary tree. The case presented highlights this, as well as the importance of the phosphatase-bilirubin dissociation.
Report of a Case:—
A 57-year-old diabetic man was admitted to the hospital with a three-month history of anorexia, a 25-lb weight loss, epigastric pain, and intermittent pruritis without jaundice. A globular mass was present in the right upper quadrant. The bilirubin value was 1.5 mg/100 cc, with a direct value of 1 mg/100 cc, at the time of admission. Repeated one week later, the value was 2.25 mg/100 cc, with a direct value of 1.53 mg/100 cc.
Berliner SD, Lear PE. Jaundice Due to Cancer Of Head of the Pancreas. JAMA. 1968;205(7):535. doi:10.1001/jama.1968.03140330077021
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