Which physical findings are characteristic 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

Upon physical examination, the patient may display signs of jaundice (skin and icterus). Look for signs of dissemination of cancer (eg, left supraclavicular lymph node, umbilical nodule, pelvic deposits on per rectal [P/R] or per vaginal [P/V] examination).

When the abdomen is examined, the gallbladder may be palpable (Courvoisier sign). This may be associated with underlying pancreatic malignancy. Also, look for signs of weight loss, adenopathies, and occult blood in the stool, suggesting a neoplastic lesion. In addition, note the presence or absence of splenomegaly, ascites, and collateral circulation associated with cirrhosis.

A high fever and chills suggest a coexisting cholangitis. Early recognition of primary sclerosing cholangitis is essential as fulminant sepsis may develop. [5]

Xanthomata are associated with primary biliary cirrhosis (PBC).

Excoriations suggest prolonged cholestasis or high-grade biliary obstruction.


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