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Snapshot
  • A 72-year-old woman presents to the emergency department with generalized fatigue, malaise, and right upper quadrant pain. She has a past medical history of obesity and cholelithiasis. Physical examination is notable for scleral icterus. Abdominal ultrasound demonstrates ductal dilatation without clear cause. Cross-sectional MRI demonstrates a malignancy of the intrahepatic bile duct. 
Introduction
  • Overview
    • malignancy originating from the epithelial cells of the bile ducts 
      • most commonly affecting the extrahepatic bile ducts
  • Epidemiology
    • demographic
      • slightly more common in men
    • risk factors
      • chronic inflammation
        • e.g., cholelithiasis and choledocholithiasis
      • liver fluke infections
        • Clonorchis sinensis
        • Opisthorchis viverrini
Presentation
  • Symptoms
    • secondary to biliary obstruction
      • pruritus
      • jaundice
      • clay-colored stools
      • dark urine
  • Physical exam
    • right upper quadrant mass (~10% of cases)
Imaging
  • Abdominal ultrasound
    • indication
      • initial imaging study when evaluating for causes of biliary obstruction
  • Cross-sectional CT or MRI 
    • indication
      • preferred imaging study when evaluating cholangiocarcinoma
Differential
  • Gallbladder cancer
    • differentiating factor
      • imaging study demonstrates involvement of the gallbladder
Treatment
  • Treatment is geared towards the staging of the malignancy
    • e.g., radiotherapy with chemotherapy
Complications
  • Biliary obstruction
  • Pancreatic duct obstruction

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