Internal Medicine

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

Choledochal Cysts Cholestasis 305

➣cholangiocarcinoma (15% overall; 2.5% with type III cysts)

➣cancer of the gallbladder

➣rare complications: portal hypertension, portal vein thrombosis,

spontaneous cyst rupture, cirrhosis, pancreatic cancer

Prognosis

■incidence of carcinoma does not fall to zero even with excision

■type V: recurrent episodes of bacterial cholangitis (2 to 20 per year)

■prognosis poor with frequent episodes of cholangitis

Cholestasis.........................................

AIJAZ AHMED, MD

history & physical

History

■gender and comorbid conditions: a 50-year-old woman with thy-

roiditis and cholestasis is likely to have primary biliary cirrhosis

(PBC); a 35-year-old man with ulcerative colitis and cholestasis is

suspicious for primary sclerosing cholangitis (PSC)

■familial causes of cholestasis/jaundice

■cholestasis of pregnancy

■recent hepatitis or infectious mononucleosis virus; foreign travel

■history of alcohol use

■hepatotoxic drug exposure

■herbal remedies: mistletoe and bush tea

■recent surgery (multiple transfusions, resorption of hematoma, hep-

atic ischemia, decompensation of subclinical liver disease), Gilbert’s

syndrome, total parenteral nutrition, sepsis

■occupation: leptospirosis in farm/sewer workers; chemicals in refuse

handlers; carbon tetrachloride in dry cleaning; vinyl chloride in plas-

tic industry

Signs & Symptoms

■fatigue most common early symptom

■pruritus, dark urine and pale/clay colored stools

■skin pigmentation, excoriations, xanthelasma and xanthomas