Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- right upper quadrant (RUQ)/upper abdominal pain
- RUQ/upper abdominal tenderness
- jaundice
- fever
Risk factors
- age >50 years
- cholelithiasis
- benign stricture
- malignant stricture
- post-procedure injury of bile ducts
- history of primary sclerosing cholangitis
- history of secondary sclerosing cholangitis
- HIV infection
Diagnostic investigations
1st investigations to order
- FBC
- serum urea
- serum creatinine
- ABG analysis
- serum LFTs
- CRP
- serum potassium
- serum magnesium
- blood cultures
- coagulation panel
- transabdominal ultrasound
- endoscopic retrograde cholangiopancreatography (ERCP)
Investigations to consider
- abdominal CT scan with intravenous contrast
- magnetic resonance cholangiopancreatography (MRCP)
- percutaneous trans-hepatic cholangiography (PTC)
- endoscopic ultrasonography (EUS)
Treatment algorithm
Contributors
Expert advisers
Professor of Medicine
Division of Gastroenterology
Department of Internal Medicine
Huntsman Cancer Institute
University of Utah
Salt Lake City
UT
Disclosures
DGA has consulted for Boston Scientific and Merit Medical, who make endoscopic retrograde cholangio-pancreatography (ERCP) products. He is also an author of references cited in this topic.
Peer reviewers
Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon
Manchester Royal Infirmary
Manchester
UK
Disclosures
CM declares that he has no competing interests.
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Disclosures
DJH declares that he has no competing interests.
Professor of Medicine
Division of Gastroenterology & Hepatology
Mayo Clinic Rochester
Rochester
MN
Disclosures
TB declares that he has no competing interests.
Consultant Hepatologist
The Liver and Hepatobiliary Unit
Queen Elizabeth Medical Care Unit
University Hospitals Birmingham NHS Foundation Trust
Birmingham
UK
Disclosures
DF declares that he has no competing interests.
Clinical Scientist
University of Birmingham
Honorary Consultant
Liver Transplant Unit
University Hospitals Birmingham NHS Foundation Trust
Birmingham
UK
Disclosures
BE declares that he has no competing interests.
Editors
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Head of Editorial, BMJ Best Practice
Disclosures
AE declares that she has no competing interests.
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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