Biliary Obstruction Clinical Presentation

Updated: Nov 27, 2016
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Presentation

History

Patients commonly complain of pale stools, dark urine, jaundice, and pruritus.

The following considerations are important:

  • Patients' ages and associated conditions
  • The presence or absence of pain
  • The location and characteristics of the pain
  • The acuteness of the symptoms
  • The presence of systemic symptoms (eg, fever, weight loss)
  • Symptoms of gastric stasis (eg, early satiety, vomiting, belching)
  • History of anemia
  • Previous malignancy
  • Known gallstone disease
  • Gastrointestinal bleeding
  • Hepatitis
  • Previous biliary surgery
  • Diabetes or diarrhea of recent onset

Also, explore the use of alcohol, drugs, and medications.

Next:

Physical Examination

Upon physical examination, the patient may display signs of jaundice (skin and icterus).

When the abdomen is examined, the gallbladder may be palpable (Courvoisier sign). This may be associated with underlying pancreatic malignancy. Also, look for signs of weight loss, adenopathies, and occult blood in the stool, suggesting a neoplastic lesion. In addition, note the presence or absence of ascites and collateral circulation associated with cirrhosis.

A high fever and chills suggest a coexisting cholangitis.

Abdominal pain may be misleading; some patients with CBD calculi have painless jaundice, whereas some patients with hepatitis have distressing pain in the right upper quadrant. Malignancy is more commonly associated with the absence of pain and tenderness during the physical examination.

Xanthomata are associated with primary biliary cirrhosis (PBC).

Excoriations suggest prolonged cholestasis or high-grade biliary obstruction.

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