A man on return from a country complains of pain in abdomen, jaundice, with increased alkaline phosphatase and conjugated hyperbilirubinemia. USG shows blockage in the biliary tree. What could be the cause –
A man on return from a country complains of pain in abdomen, jaundice, with increased alkaline phosphatase and conjugated hyperbilirubinemia. USG shows blockage in the biliary tree. What could be the cause –
💡 Explanation
## **Core Concept**
The patient's symptoms of abdominal pain, jaundice, increased alkaline phosphatase, and conjugated hyperbilirubinemia, along with ultrasound (USG) evidence of biliary tree blockage, point towards an obstructive jaundice. Obstructive jaundice occurs due to a blockage in the bile ducts, which prevents the flow of bile into the intestine. This can be caused by various factors including gallstones, biliary strictures, or parasitic infections.
## **Why the Correct Answer is Right**
The correct answer, **D. Ascaris lumbricoides**, is a plausible cause for obstructive jaundice, especially in a patient returning from a country where this parasitic infection is common. Ascaris lumbricoides, a large intestinal roundworm, can occasionally migrate into the biliary tree and cause obstruction. This condition is more likely in areas with poor sanitation and hygiene. The presence of the worm in the biliary tree can lead to symptoms of obstructive jaundice, including jaundice, abdominal pain, and elevated levels of alkaline phosphatase and conjugated bilirubin.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While certain bacteria can cause biliary infections, they are less likely to cause a physical blockage in the biliary tree leading to obstructive jaundice directly.
- **Option B:** Giardiasis can cause gastrointestinal symptoms and occasionally malabsorption but is not typically associated with obstructive jaundice through physical blockage of the biliary tree.
- **Option C:** Entamoeba histolytica primarily causes amoebic dysentery and liver abscesses but is not commonly associated with direct blockage of the biliary tree.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that in areas endemic for certain parasitic infections, these should be considered in the differential diagnosis for obstructive jaundice. Ascaris lumbricoides infection is a classic cause of obstructive jaundice in such settings, particularly in South Asia and other tropical regions.