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Updated: Dec 27 2021


  • 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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