Last reviewed: 25 Jun 2021
Last updated: 19 Feb 2021

Summary

Definition

History and exam

Key diagnostic factors

  • right upper quadrant (RUQ)/upper abdominal pain
  • RUQ/upper abdominal tenderness
  • jaundice
  • fever

Other diagnostic factors

  • pale stools
  • pruritus
  • hypotension
  • mental status changes

Risk factors

  • age >50 years
  • cholelithiasis
  • benign stricture
  • malignant stricture
  • postprocedure injury of bile ducts
  • history of primary sclerosing cholangitis
  • history of secondary sclerosing cholangitis
  • HIV infection

Diagnostic investigations

1st investigations to order

  • CBC
  • serum BUN
  • 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)
  • endoscopic ultrasonography (EUS)
  • percutaneous trans-hepatic cholangiography (PTC)
  • surgical approaches

Treatment algorithm

Contributors

Authors

Douglas G. Adler, MD, FACG, AGAF, FASGE

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, which make endoscopic retrograde cholangiopancreatography (ERCP) products. He is also an author of references cited in this topic.

Acknowledgements

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

Disclosures

ASF declares that he has no competing interests.

Peer reviewers

Christian Macutkiewicz, MD, FHEA, FRCS

Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon

Manchester Royal Infirmary

Manchester

UK

Disclosures

CM declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Todd Baron, MD

Professor of Medicine

Division of Gastroenterology & Hepatology

Mayo Clinic Rochester

Rochester

MN

Disclosures

TB is an author of a reference cited in this topic.

Dennis Freshwater, MB, BS, MD, FRCP

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.

Bertus Eksteen, MRCP, PhD, MRC

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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