Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

300 Cholangiocarcinoma

➣choledochal cysts

➣Caroli’s disease

➣Oriental cholangiohepatitis due to Clonorchis sinensis, also

Opisthorchis

➣chronic choledocholithiasis

➣exposure to thorium dioxide

Signs & Symptoms

■abdominal pain

■pruritus

■jaundice

■anorexia and weight loss

■weakness and fatigue

■cholangitis

■Courvoisier’s sign: palpable, nontender gallbladder accompanied by

■jaundice if the tumor is below the cystic duct takeoff

■jaundice

■abdominal mass.

■hepatomegaly

■1% involve only intrahepatic ducts and present as liver mass

tests

Basic Tests

■elevation of alkaline phosphatase

■elevated bilirubin, often >20 mg/dl

■CA 19–9 >100 U/ml in∼60%

■aminotransferases variably normal or mildly elevated

■increased prothrombin time with prolonged obstruction

■rarely hypercalcemia

Special Tests

■Ultrasound

➣dilatation of the biliary system to the level of the obstruction,

extensive intrahepatic dilatation except in PSC; may or may not

show a mass

■CT scan

➣similar to ultrasound

■ERCP

➣able to locate the area of obstruction and get brush cytology

(positive in 50∼75%).