A patient with obstructive jaundice due to pancreatic cancer might have all of the following clinical findings except
**Core Concept**
Obstructive jaundice is characterized by the accumulation of conjugated bilirubin in the blood, leading to a range of clinical manifestations. This condition often results from a mechanical obstruction of the bile ducts, such as that caused by pancreatic cancer.
**Why the Correct Answer is Right**
In obstructive jaundice, the liver's ability to conjugate bilirubin is not impaired, but the flow of bile into the intestine is blocked. This leads to a buildup of conjugated bilirubin in the blood, causing jaundice, dark urine, and pale stools. The patient may also experience pruritus (itching) due to the accumulation of bile salts in the skin.
**Why Each Wrong Option is Incorrect**
* **Option A:** Weight loss, fatigue, and abdominal pain are common symptoms of pancreatic cancer and may be associated with obstructive jaundice.
* **Option B:** Pruritus is a characteristic symptom of obstructive jaundice, often due to the accumulation of bile salts in the skin.
* **Option C:** The absence of a fever is a distinguishing feature of obstructive jaundice, which is typically a low-grade fever, unlike cholangitis, which is a high-grade fever.
**Clinical Pearl / High-Yield Fact**
In obstructive jaundice, the serum alkaline phosphatase (ALP) level is typically elevated, whereas in cholestasis, the serum transaminases (AST and ALT) are elevated.
**Correct Answer: D.**