24th July 2023

A 42-year-old woman with a background of hypertension presents to A&E with a 1-week history of progressive jaundice

A 42-year-old woman with a background of hypertension presents to A&E with a 1-week history of progressive jaundice. She reports loose stools, which on questioning describes as “different than normal”. There is no associated abdominal or back pain. She doesn’t think she has lost any weight but has felt unusually tired. She drinks around 30 units of alcohol a week, which she states is due to stress from her work as an accountant.

On examination, she is of a considerably high BMI, mild icterus is noted, and her abdomen is soft and non-tender with no organomegaly. She is afebrile.

Which of the following features from history make a diagnosis of cholangiocarcinoma more likely than gallstone-related disease?

Select the SINGLE most appropriate option from the list below. Select ONE option only.