Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive painless jaundice, dark urine, and acholic stools. Associated symptoms include pruritus, unintentional weight loss, and vague right upper quadrant discomfort. No history of fever or rigors suggestive of cholangitis. Biliary imaging (MRCP/CT) confirms a hilar stricture consistent with Klatskin tumor (Bismuth-Corlette classification: [Type I/II/IIIa/IIIb/IV]).
Clinical Examination Findings
Physical exam reveals scleral icterus and generalized jaundice. Abdominal exam shows a non-tender, palpable gallbladder (Courvoisierโs sign may be absent if proximal). No evidence of hepatomegaly or ascites. Surgical scars noted: [None/Previous cholecystectomy]. Performance status (ECOG): [0-4].
Treatment Protocol
Surgical plan: Radical resection of the hilar cholangiocarcinoma including en-bloc caudate lobectomy and regional lymphadenectomy. Reconstruction via Roux-en-Y hepaticojejunostomy. Pre-operative biliary drainage considered if cholangitis present or if future liver remnant volume is insufficient. Adjuvant therapy (Gemcitabine/Cisplatin) pending final pathology and margin status.