Blocked duodenal papilla-(moore and dalley, p 288.) the likely cause of the elevated bilirubin is a blocked pancreatic and bile duct at the duodenal papilla. pancreatic cancer (usually ductal adenocarcinoma) frequently arises from the head of the pancreas where it blocks the normal flow of bile out of the liver, via the hepatic duct and gallbladder, via the cystic duct which join to form the (common) bile duct that passes through the substance of the head of the pancreas where it joins the main pancreatic duct just before forming the hepatopancreatic ampulla at the second portion of the duodenum (see moore & dalley, p 283). as a consequence of the blockage [not open hepatic duct (answer c)] of the normal exit of bile from the body bilirubin levels increase and jaundice (yellowing) develops. blockage of the cystic duct (answer b) may just lead to a gallbladder enlargement/inflammation. viral hepatitis (answer a) would normally not be associated with pancreatic cancer. gilbert syndrome (answer e) is due to mild, chronic unconjugated hyperbilirubinemia and is not involved.
