Painless Jaundice

The presentation is classic: a patient presents with painless jaundice, weight loss, and fatigue. Even without imaging, the diagnosis of pancreatic cancer pops into your mind.

With this presentation, after getting CBC, renal panel, LFTs, amylase, lipase, and perhaps a CA 19-9, the next diagnostic step is to get a CT scan of the abdomen to look for a pancreatic mass. Then an endoscopic ultrasound can be performed to both better visualize the mass and to obtain tissue samples through fine needle aspiration to confirm whether or not the mass is malignant. Another imaging modality that can be used to evaluate staging of a pancreatic mass is magnetic resonance imaging, especially used to evaluate hepatic lesions. EUS and CT are still the diagnostic modalities of choice. Another use for endoscopic ultrasound is evaluating the common bile duct for stones in acute pancreatitis.