Bile Duct Tumors Clinical Presentation

Updated: Nov 18, 2015
  • Author: Todd A Nickloes, DO, FACOS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History

Jaundice is the usual presenting symptom, followed by pruritus, which is a feature distinguishing a bile duct tumor from biliary cirrhosis. Jaundice is delayed if only one main hepatic duct is involved, because the unaffected lobe of the liver can compensate.

One third of patients present with mild epigastric pain. Diarrhea, anorexia, and weight loss are the other presenting symptoms.

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Physical Examination

On examination, patients usually are deeply jaundiced. Cholangitis usually occurs only if previous endoscopic, percutaneous, or surgical biliary interventions have been performed. The liver may be large and smooth.

In distal bile duct tumors, a distended, nontender gallbladder may be present. If such patients undergo surgery and exploration confirms absence of involvement of the junction of the cystic duct and the common bile duct (CBD) by tumor, the gallbladder may be used for bypass procedures.

Cases with involvement of only one duct at the hilum present with mild abdominal pain, unilobar hepatic enlargement, and elevated serum alkaline phosphatase and gamma glutamyl transferase without any elevation of serum bilirubin.

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