Female 75 years old Reason: doubling of bilirubin overnight, severe abdominal pain, bladder cancer, with G tube, ileal conduit, s/p ileocolic bypass History: please evaluate for micrometastasis ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No intrahepatic biliary ductal dilatation.Gallbladder contains sludge and debris. Common bile duct is normal in caliber. There is a questionable filling defect in the distal common bile duct about the ampulla which may represent an ampulla itself or a small stone which is suboptimally evaluated. There is an adjacent duodenal diverticula.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hydronephrosis with likely papillary necrosis with some layering filling defects in the left kidney which may represent likely sludge or papillary necrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy catheter terminates within the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large volume ascites.
1.Cholelithiasis without biliary ductal dilatation. Given the small size of the stones the elevated bilirubin may be due to a recently passed stone. Please see additional discussion above.