Last reviewed:September 2019
Last updated:January  2019

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

Other diagnostic factors

  • acholic stools
  • pruritus
  • hypotension
  • mental status changes

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
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • transabdominal ultrasound
Full details

Investigations to consider

  • abdominal CT scan with intravenous contrast
  • magnetic resonance cholangiopancreatography (MRCP)
  • percutaneous trans-hepatic cholangiography (PTC)
  • surgery/laparotomy with common bile duct exploration
Full details

Emerging tests

  • endoscopic ultrasonography (EUS)
Full details

Treatment algorithm

Contributors

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 BSC and Merit, who make endoscopic retrograde cholangio-pancreatography (ERCP) products. He is also an author of references cited in this topic.

Dr Douglas G. Adler would like to gratefully acknowledge Dr Andrew S. Fedoravicius, a previous contributor to this topic.

Peer reviewersVIEW ALL

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.

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