56-year-old male presented to the

emergency by epigastric pain irradiating

to the right upper quadrant, nausea and
food-bilious vomiting and mild jaundice.
The analysis carried out was:
hemoglobin 13.2, leukocytes 21000,
with 80% neutrophils, platelets 190000,
glucose 103, urea 25, creatinine 0.8,
albumin 5.3, AST 87, ALT 80, GGT 60,
total bilirubin 2.5, alkaline phosphatase
400, amylase 35, sodium 138, potasium
4. Abdominal ultrasound is performed to
demonstrate the existence of pancreas,
1) Ampulloma.
2) Choledocholithiasis.
3) Mirizzi syndrome.
4) Intrahepatic cholangiocarcionma.