A 50 years old patient presented with progressive jaundice. Liver function test was done in which conju!gated serum bilirubin-4.8% and total bilirubin-6.7%, alkaline phosphatase- 550 IU, SGOT-50, SGPT-65. Most probable diagnosis is;
Jaundice due to choledocholithiasis
Dubin-Johnson syndrome
Viral hepatitis
Malignant obstructive jaundice
Answer- A. Jaundice due to choledocholithiasisThe maximum bilirubin level is seldom >256.5 micromol/L (15.0 mg/dl) in patients wilh choledocholithiasis unless concomitant hepatic disease or anotherfactor leading to marked hyperbilirubinemia exists.'-Harrison I8/e p2625.'Serum bilirubin levels >342.0 micromol/L (20 mg/dL) should suggest the possibility of neoplastic obstruction.'-Harrisonl8/e p2625CholedocholithiasisCBD stones should be suspected in any patient with cholecystitis whose serum bilirubin level is >85.5 micromol/L (5 mg/dL).The maximum bilirubin level is seldom >256.5 micromol/L (15.0 mg/dl) in patients with choledocholithiasis.