stanford school of medicine logotitle logo
advanced

 

 

Cardiology

 

Endocrinology

 

Gastroenterology

 

General Inpatient Medicine

 

Hematology

 

Infectious Disease

 

Nephrology

 

Neurology

 

Oncology

 

Outpatient & Preventative Medicine

 

Palliative Care

 

Psychiatry

 

Pulmonary/Critical Care

 

Rheumatology

Obstructive Jaundice (Cholangiocarcinoma)


usually due to stones or tumor


ROS: Painless jaundice suggests malignancy whereas choledocholithiasis often p/w colicky abdominal pain


PE: jaundice, abd ttp. Courvoisier's sign is the presence of a palpable GB due to malignancy as tumor causes biliary obstruction and progressive dilatation of the intrahepatic bile ducts. Choledocholithiasis has an acute presentation so GB does not distend


Labs: choledocholithiasis rarely causes t bili>15; tbili>20 suggestive of malignancy. Alk phos may rise before t bili and fall before t bili(after obstruction resolved). AST/ALT may be 4-10 x nl in acute obstruction


Management: Most patients who present with cholangiocarcinoma are not candidates for curative surgical therapy but require palliation for biliary obstruction with decompression using endoscopic, percutaneous, or surgical approaches
Gemcitabine has shown some promise
Other treatment modalities include radiation, phototherapy, transplant (when localized) but prognosis remains poor unless disease caught early and excised.

 


 

(Ellen Eaton MD, 9/28/10)