Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive jaundice, right upper quadrant discomfort, and constitutional symptoms. History of known HCC. Current presentation suggestive of biliary obstruction secondary to tumor thrombus/invasion. Associated symptoms include pruritus, acholic stools, and dark urine. No current evidence of cholangitis (fever/rigors).
Clinical Examination Findings
General: Scleral icterus present. Abdomen: Soft, non-distended, tenderness noted in RUQ, no rebound or guarding. Liver edge palpable, firm, non-pulsatile. Murphy’s sign negative. No peripheral edema or stigmata of chronic liver disease (spider angiomata, palmar erythema).
Treatment Protocol
Plan: 1. Urgent imaging (MRI/MRCP) to delineate biliary anatomy and extent of tumor thrombus. 2. Liver function tests and coagulation profile. 3. Consider biliary decompression (ERCP/PTC) if obstructive jaundice is severe or cholangitis develops. 4. Multidisciplinary tumor board review for systemic therapy vs. locoregional intervention.