Biliary Obstruction Clinical Presentation

Updated: Oct 16, 2019
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS  more...
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Patients commonly complain of yellow skin and eyes, 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 course of the jaundice (ie, progressive, intermittent, fluctuating)

  • The presence of systemic symptoms (eg, fever, anorexia, weight loss)

  • Symptoms of gastric outlet obstruction or 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

  • Abdominal pain may be misleading; some patients with common bile duct 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.

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


Physical Examination

Upon physical examination, the patient may display signs of jaundice (skin and icterus). Look for signs of dissemination of cancer (eg, left supraclavicular lymph node, umbilical nodule, pelvic deposits on per rectal [P/R] or per vaginal [P/V] examination).

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 splenomegaly, ascites, and collateral circulation associated with cirrhosis. Nodular enlarged liver suggests metastases in malignant biliary obstruction.

A high fever and chills suggest a coexisting cholangitis. Early recognition of primary sclerosing cholangitis is essential as fulminant sepsis may develop. [5]

Xanthomata are associated with primary biliary cirrhosis (PBC).

Excoriations suggest prolonged cholestasis or high-grade biliary obstruction.