Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive painless jaundice, associated with pruritus, dark-colored urine, and acholic stools. Significant weight loss (approx. [X] kg over [X] months) noted. Denies fever or chills. Reports early satiety and vague epigastric discomfort. No history of biliary colic or pancreatitis.
Clinical Examination Findings
General: Patient appears jaundiced, cachectic. Abdomen: Soft, non-tender, non-distended. Courvoisierโs sign: Palpable, non-tender gallbladder noted. No hepatosplenomegaly. Bowel sounds present. Skin: Excoriations noted secondary to pruritus. No peripheral edema.
Treatment Protocol
Surgical intervention indicated: Pylorus-preserving pancreaticoduodenectomy (Whipple procedure) is the gold standard for resectable ampullary carcinoma. Pre-operative biliary drainage via ERCP/stenting considered if bilirubin > [X] mg/dL or cholangitis present. Post-operative management includes nutritional support, pancreatic enzyme replacement, and monitoring for delayed gastric emptying.