Case history
Case history
A 65-year-old woman presents to her primary care physician with a 4-month history of intermittent abdominal pain localized to the right upper quadrant (RUQ) with radiation to the epigastrium; the pain increases with the ingestion of fatty food and decreases with fasting. In the last 2 weeks the pain has been more frequent and steady. The patient complains of nausea, pruritus, anorexia, and weight loss, which she relates to the lack of appetite. At physical examination, there is RUQ tenderness and jaundice of the conjunctival sclera. No lymphadenopathy or palpable masses are found.
Other presentations
The clinical diagnosis of biliary tract tumors is very difficult due to lack of specific symptoms. When the classic symptoms (jaundice, weight loss, anorexia, and right upper quadrant pain) appear, the disease is usually in a more advanced stage. The clinical presentation depends largely on the location of the tumor, and the presence or absence of obstructive jaundice. Patients with early tumors that have not yet obstructed the bile duct may present with vague abdominal pain and LFT abnormalities. In advanced cases of distal extrahepatic cholangiocarcinoma, a distended palpable gallbladder may be present without pain and obstructive jaundice (Courvoisier sign).
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