Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- painless jaundice
- weight loss
- abdominal pain
Other diagnostic factors
- pruritus
- triad of fever, jaundice, and RUQ pain
- palpable gallbladder
- hepatomegaly
- dark urine
- pale stools
Risk factors
- age >50 years
- cholangitis
- choledocholithiasis
- cholecystolithiasis
- other structural disorders of the biliary tract
- ulcerative colitis (UC)
- primary sclerosing cholangitis (PSC)
- non-specific cirrhosis
- alcoholic liver disease
- liver fluke infection
- chronic typhoid carrier
- hepatitis C virus (HCV)
- HIV
- hepatitis B virus (HBV)
- exposure to thorium dioxide
- diabetes
- cigarette smoking
- exposure to toxins/medicines
- male sex
Diagnostic investigations
1st investigations to order
- serum bilirubin
- serum alk phos
- serum gamma-GT
- serum aminotransferase
- serum prothrombin time
- serum CA 19-9
- serum carcinoembryonic antigen (CEA)
- serum CA 19-9 + (40 times CEA)
- serum CA-125
- abdominal ultrasound
Investigations to consider
- abdominal CT
- abdominal MRI
- MR angiography
- ERCP
- MRCP
- percutaneous transhepatic catheterisation (PTC)
- positron emission tomography (PET)
- Immunostaining
Emerging tests
- optical coherence tomography (OCT)
- peroral cholangioscopy
- duodenoscope-assisted cholangioscopy
Treatment algorithm
resectable disease
unresectable disease
Contributors
Authors
N. Joseph Espat, MD, MS, FACS
Chairman of Surgery
Professor and Chief Surgical Oncology
Director Cancer Center
Department of Surgery
Roger Williams Medical Center
Boston University School of Medicine
Providence
RI
Disclosures
NJE declares he has no competing interests.
Ponnandai Somasundar, MD, MPH, FACS
Associate Professor and Associate Chief
Surgical Oncology
Department of Surgery
Roger Williams Medical Center
Boston University School of Medicine
Providence
RI
Disclosures
PS is an advisory board member for RWMC, and a clinical board consultant for Medtronic HPB.
Peer reviewers
Kevin Watkins, MD
Assistant Professor
Department of Surgery
Health Science Center
SUNY
Stony Brook
NY
Disclosures
KW declares that he has no competing interests.
Savio Reddymasu, MD
GI Fellow
Department of Medicine
Center for Gastrointestinal Motility
Division of Gastroenterology and Hepatology
University of Kansas Medical Center
Kansas City
KS
Disclosures
SR declares that he has no competing interests.
Satvinder Mudan, MBBS, BSc, MD, FRCS
Consultant in Surgical Oncology
The Royal Marsden Hospital
London
UK
Disclosures
SM declares that he has no competing interests.
Differentials
- Hepatocellular carcinoma (HCC)
- Ampullary carcinoma
- Pancreatic carcinoma
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: hepatobiliary cancers
- Adjuvant therapy for resected biliary tract cancer: ASCO clinical practice guideline
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