What should be the focus of clinical history in the evaluation of biliary obstruction?

Updated: Oct 16, 2019
  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Answer

The following considerations are important:

  • Patients' ages and associated conditions

  • The presence or absence of pain

  • The location and characteristics of the pain

  • The acuteness of the symptoms

  • The course of the jaundice (ie, progressive, intermittent, fluctuating)

  • The presence of systemic symptoms (eg, fever, anorexia, weight loss)

  • Symptoms of gastric stasis (eg, early satiety, vomiting, belching)

  • History of anemia

  • Previous malignancy

  • Known gallstone disease

  • Gastrointestinal bleeding

  • Hepatitis

  • Previous biliary surgery

  • Diabetes or diarrhea of recent onset

  • Abdominal pain may be misleading; some patients with common bile duct calculi have painless jaundice, whereas some patients with hepatitis have distressing pain in the right upper quadrant. Malignancy is more commonly associated with the absence of pain and tenderness during the physical examination.

Also, explore the use of alcohol, drugs, and medications.


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