Biliary stones (most common) | Abdominal pain, elevated liver enzyme levels and dilated biliary tree |
Benign stricture |
Primary sclerosing cholangitis | Asymptomatic or symptoms such as fatigue and pruritus; usually associated with colitis; elevated liver enzyme levels; multifocal stricturing causing a beaded appearance in the biliary tree |
Chronic pancreatitis with stricturing of the distal bile duct | Abdominal pain and elevated liver enzyme levels; symptomatic obstruction of the bile duct caused by inflammation and fibrosis in the head of the pancreas, or a pseudocyst |
Malignant stricture |
Pancreas, ampulla of Vater, bile duct | Painless jaundice and constitutional symptoms; dilated biliary tree |
Choledochal cyst | Congenital anomaly; presents as recurrent abdominal pain and cholangitis; isolated or combined dilatations of the extra- and intrahepatic biliary trees |
Drug reaction | May mimic viral hepatitis or biliary tract disease; rash, arthralgia and eosinophilia can be clues |
Infection |
Bacterial/mycobacterial |
Abscess | Fevers, chills, rigors; obstructive symptoms |
Tuberculoma | Appropriate exposure history |
Parasitic |
Ascariasis | |
Ascaris lumbricoides | Endemic in Asia, Africa and South Africa; resides in the small intestine, but may migrate into aberrant sites, such as the bile duct, through the papilla causing biliary colic and obstructive jaundice |
Liver flukes |
Fascioliasis (Fasciola hepatica, Fasciola gigantica) | Endemic in South America, North Africa, Asia and Europe; biliary obstruction, cholangitis, cirrhosis |
Opisthorchiasis |
Opisthorchis viverrini | Endemic in Thailand, Laos, Cambodia and Vietnam; cholangitis, cholangiocarcinoma |
Opisthorchis felinus | Endemic in Russia, Siberia, Ukraine and Kazakhstan; suppurative cholangitis and liver abscess |
Clonorchiasis |
Clonorchis sinensis | Endemic in Northeast China, southern Korea, Japan, Taiwan, northern Vietnam and far east Russia; gallbladder and intrahepatic duct stone, recurrent pyogenic cholangitis, cholecystitis, liver abscess |