A 50 years old woman presented with pain in upper right and mid quadrant of abdomen,nausea and vomiting.H/ o taking flavonoids capsule empty stomach for the last 2 months. Investigations:- Hb 10.1gm/dl ,platelets137000, rbc and wbc normal,kft normal, sgot and sgpt elevated by 10 times upper limit. Total bilirubin 10.52 mg/dl, direct 9.56 mg/ dl.( 10 days back Total bilirubin was 3mg/ dl ,direct 2.3mg/ dl.) Tests for viral and immune pathology of liver are negative.
U/S:-first report liver normal,gallbladder contracted, Second report from different center IHBR markedly dilated,gallbladder contracted advised MRI to rule out obstructive pathology. MRI :- Hilar mass with obstructive biliopathy, cholangiocarcinoma with multiple hepatic lesions,appearance like hepatic and lymph nodes metastasis. What is the further line of action in management of this case?Please share your expert advice.
