Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with [duration] history of intermittent right upper quadrant (RUQ) abdominal pain, associated with episodes of obstructive jaundice, pruritus, and occasional acholic stools. No history of primary sclerosing cholangitis or hepatolithiasis. Patient reports [weight loss/anorexia/fever]. Clinical suspicion for IPNB based on imaging findings of intraductal mass/dilated bile ducts.
Clinical Examination Findings
Abdominal exam: Soft, non-distended, tenderness noted in RUQ without rebound or guarding. Murphy’s sign [positive/negative]. Scleral icterus present/absent. Hepatomegaly noted/not noted. No palpable gallbladder or masses. Bowel sounds present.
Treatment Protocol
Plan: Surgical resection (biliary duct excision with lymphadenectomy) is the gold standard. Pre-operative biliary drainage via ERCP/PTC indicated for symptomatic jaundice or cholangitis. Intra-operative frozen section to assess resection margins. Post-operative surveillance with serial CA 19-9 levels and cross-sectional imaging (MRI/MRCP).