Summary
Definition
History and exam
Key diagnostic 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
- asymptomatic
Risk factors
- age >50 years
- cholangitis
- choledocholithiasis
- cholecystolithiasis
- other structural disorders of the biliary tract
- ulcerative colitis (UC)
- primary sclerosing cholangitis (PSC)
- nonspecific 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/medications
- male sex
Diagnostic investigations
1st investigations to order
- serum bilirubin
- serum alkaline phosphatase
- serum gamma-GT
- serum aminotransferase
- serum prothrombin time
- serum CA 19-9
- serum carcinoembryonic antigen (CEA)
- serum CA-125
- abdominal ultrasound
- abdominal CT
- abdominal MRI
Investigations to consider
- endoscopic ultrasound (EUS)
- MR angiography
- ERCP
- MRCP
- percutaneous transhepatic catheterization (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
- AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma
- Biliary tract cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
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