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Obstructive jaundice / cholangitis in PDAC: total bilirubin ≥3 mg/dL with pancreatic-head...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-PDAC-BILIARY-OBSTRUCTION-CHOLANGITIS
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-PDAC
SourcesSRC-ESMO-PANCREATIC-2024 SRC-NCCN-PANCREATIC-2025

Red Flag Origin

DefinitionObstructive jaundice / cholangitis in PDAC: total bilirubin ≥3 mg/dL with pancreatic-head mass causing biliary tree dilation, OR active cholangitis (fever + RUQ pain + jaundice). Mandates biliary drainage (ERCP-stent or PTC) BEFORE chemo, which is hepatotoxic and reduces clearance of cytotoxics.
Clinical directionhold
Categoryorgan-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "total_bilirubin_mg_dl",
          "threshold": 3
        },
        {
          "finding": "biliary_dilation",
          "value": true
        }
      ]
    },
    {
      "finding": "active_cholangitis",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

~70% of head-of-pancreas tumors present with jaundice. Biliary stent (preferred metallic for life expectancy >3 mo, plastic for shorter) via ERCP first-line; PTC if ERCP fails. Resolve bilirubin to <2 mg/dL before initiating gem-nab-pac or FOLFIRINOX (irinotecan in FOLFIRINOX is hepatically cleared — dose-modify or omit if bilirubin >ULN).

Used By

Indications