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BiliaryObstructionClinicalPresentation
Updated:Nov27,2016
Author:JenniferLynnBonheur,MDChiefEditor:VinayKumarKapoor,MBBS,MS,FRCS,FAMS
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PRESENTATION

History
Patientscommonlycomplainofpalestools,darkurine,jaundice,andpruritus.
Thefollowingconsiderationsareimportant:
Patients'agesandassociatedconditions
Thepresenceorabsenceofpain
Thelocationandcharacteristicsofthepain
Theacutenessofthesymptoms
Thepresenceofsystemicsymptoms(eg,fever,weightloss)
Symptomsofgastricstasis(eg,earlysatiety,vomiting,belching)
Historyofanemia
Previousmalignancy
Knowngallstonedisease
Gastrointestinalbleeding
Hepatitis
Previousbiliarysurgery
Diabetesordiarrheaofrecentonset
Also,exploretheuseofalcohol,drugs,andmedications.

PhysicalExamination
Uponphysicalexamination,thepatientmaydisplaysignsofjaundice(skinandicterus).
Whentheabdomenisexamined,thegallbladdermaybepalpable(Courvoisiersign).Thismaybe
associatedwithunderlyingpancreaticmalignancy.Also,lookforsignsofweightloss,adenopathies,
andoccultbloodinthestool,suggestinganeoplasticlesion.Inaddition,notethepresenceor
absenceofascitesandcollateralcirculationassociatedwithcirrhosis.
Ahighfeverandchillssuggestacoexistingcholangitis.
AbdominalpainmaybemisleadingsomepatientswithCBDcalculihavepainlessjaundice,whereas
somepatientswithhepatitishavedistressingpainintherightupperquadrant.Malignancyismore
commonlyassociatedwiththeabsenceofpainandtendernessduringthephysicalexamination.
Xanthomataareassociatedwithprimarybiliarycirrhosis(PBC).

Excoriationssuggestprolongedcholestasisorhighgradebiliaryobstruction.
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