OJ

Must ask Questions

Progression of jaundice

If present, likely malignant

Intermittency

If present, CBD stone or periampullary CA likely

Courvoisier’s law

In a patient with painless jaundice and an enlarged gallbladder, the cause is unlikely to be gallstones.
(because stones would have given rise to chronic inflammation and subsequently fibrosis of gallbladder therefore, rendering it incapable of dilatation)

Klatskin tumor (hilar cholangiocarcinoma) is an exception.
Examination

  • Shiny nails (due to pruritis).
  • Look for palpable gallbladder.

🅽🅸🅲🅴 🆃🅾 🅺🅽🅾🆆

Investigations

  • USS is for structures above CBD
  • CT is the best Ix for CBD

If facilities are not available for a T tube cholangiogram, clamp the T tube for 24hrs and observe the pt for any symptoms like colics.