HEPATOBILIARY · MEMBERSHIP SURGERY

Obstructive jaundice — rural Volta, 55F

15 decision points ~30 min Difficulty 4/5 Membership

Setting

You are the on-call HPB fellow at a tertiary hospital in Accra. Ultrasound is on site 24/7. CT is available Monday to Friday, MRCP on Tuesday afternoons only, and ERCP is done on Tuesdays and Thursdays. Your senior consultant is in theatre and asks you to work up this new referral before ward round.

Patient

Mrs A, a 55-year-old subsistence farmer from a village outside Ho in the Volta Region, presents with three weeks of progressive yellowing of the eyes, dark urine, pale stools, and generalised itching. She has lost 6 kg over two months and has a dull epigastric ache. No fever. No prior surgery. Her district hospital referred her because 'the jaundice is not clearing.' She has walked slowly into your clinic with her daughter and can barely finish sentences without stopping.

Reference stack

Bailey & Love 28e Ch 68, 76 · Sabiston 21e Ch 55 · Blumgart 6e · van der Gaag NEJM 2010 (DROP-IN) · ESPEN 2021 · ISGPS 2016 POPF

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.