Extrahepatic biliary disorders. Bile duct tumors

1. Big picture

Extrahepatic biliary disorders are diseases affecting the bile ducts outside the liver, especially the common hepatic duct, cystic duct, common bile duct, ampulla of Vater, and the perihilar biliary confluence. Clinically, they usually present as cholestasis or obstructive jaundice.

The exam logic is:

Jaundice + dark urine + pale stool + pruritus + ↑ conjugated bilirubin, ↑ alkaline phosphatase, ↑ gamma-glutamyl transferase = obstructive/cholestatic biliary disease until proven otherwise.

The most important malignant disorder is cholangiocarcinoma, especially:

• perihilar cholangiocarcinoma / Klatskin tumor,
• distal extrahepatic bile duct cancer.

The most important emergency is:

Obstruction + infection = acute cholangitis → antibiotics + urgent biliary drainage.

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