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
Contributors
Authors
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 is a consultant for SIRTEX Medical, Medtronic, and IV Diagnostics on technical and biologic concepts of device performance. These positions are not relevant to the topic area.
Associate Professor and Associate Chief
Surgical Oncology
Department of Surgery
Roger Williams Medical Center
Boston University School of Medicine
Providence
RI
Disclosures
PS declares that he has no competing interests.
Peer reviewers
Assistant Professor
Department of Surgery
Health Science Center
SUNY
Stony Brook
NY
Disclosures
KW declares that he has no competing interests.
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.
Consultant in Surgical Oncology
The Royal Marsden Hospital
London
UK
Disclosures
SM declares that he has no competing interests.
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