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'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]]
'''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]]


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! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="3" |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="3" |Disease

Revision as of 15:03, 2 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Overview

Cholangiocarcinoma must be differentiated from other diseases that cause jaundice, abdominal pain, weight loss, and fatigue, such as gallbladder cancer, hepatocellular carcinoma, pancreatic cancer, cholecystitis, and choledochitis.

Differentiating cholangiocarcinoma from other diseases

Cholangiocarcinoma must be differentiated from other diseases that cause jaundice, abdominal pain, weight loss, and fatigue, such as:

Cholangiocarcinoma must be differentiated from other diseases such as:[1]

Intrahepatic mass-forming cholangiocarcinoma must be differentiated from:

  • Liver metastases
  • Central necrosis (high T2 signal) is more common
  • Hepatocellular carcinoma (HCC)
  • Tumor thrombus more common
  • Capsular retraction uncommon
  • May appear very similar
  • Other primary liver tumors
  • Hepatic abscess

Periductal infiltrating cholangiocarcinoma must be differentiated from:

  • Benign stricture
  • Usually short-segment
  • Regular margin
  • Symmetric narrowing
  • No ductal enhancement
  • No lymph node enlargement
  • No periductal soft-tissue mass
  • Periportal lymphangitic metastasis

Intraductal cholangiocarcinoma must be differentiated from:

  • Intraductal invasion by a HCC
  • Extraductal mass
  • Hepatolithiasis
  • No enhancement
  • Higher attenuation
  • Biliary cystadenoma or cystadenocarcinoma
  • Intratumoural cysts do not communicate with the biliary tree
  • Benign stricture

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram


Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Cholangiocarcinoma RUQ + − + + − − + − − − + Normal
  • Contrast-enhanced ultrasound
  • CT scan
    • Calcification
    • Pseudocyst
    • Dilation of main pancreatic duct
  • MRI
  • Predisposes to pancreatic cancer
Hepatocellular carcinoma/Metastasis RUQ + − + + + + + + + − +
  • Normal
  • Hyperactive if obstruction present
  • US
  • CT
  • MRI
  • Liver biopsy

Other symptoms:

Pancreatic carcinoma MidEpigastric − − + + + − + − − − + Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − − Normal
  • Normal Liver function tests
  • Normal AFP
  • Minor elevations of
    • Aspartate
    • Alanine aminotransferase
    • Alkaline phosphatase
    • Gamma glutamyl transpeptidase
  • Us
  • Multiphasic helical CT scan
  • Open biopsy if diagnosis can not be established
Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric − − + + − + + − − − − Normal
  • US
  • CT
  • MRI
Liver hemangioma Intermittent RUQ − − + + − − − − − − − Normal
  • Abnormal LFTs
Liver abscess RUQ + − + + − − + − − − − Normal
  • US
  • CT
Cirrhosis RUQ+Bloating + − + + − − + − − − − Normal US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur
Inflammatory lesions RUQ ± − + + − − − − − − − Normal US
  • Nodular,shrunken liver or coarse liver
  • Stigmata of liver disease

References

  1. ↑ Cholangiocarcinoma. Radiopaedia. http://radiopaedia.org/articles/cholangiocarcinoma

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