Case 05: Sam Spade

Intractable itching is a sign of elevated bilirubin, and sure enough, physical examation findings of scleral icterus and the lab results confirm this. This patient has painless jaundice and a palpable gallbladder—all bad signs suggesting that he has pancreatic cancer.

Abdominal plain films or a barium enema would not show much. Select another test.