Initial investigation of choice for biliary obstruction:
Ref: Sabi Mon Textbook of Surgery, / 9th Edition,Pg: 1481.Explanation:UltrasoundInvestigation of choice for the initial evaluation of jaundice or symptoms of biliary disease.Sensitive, inexpensive. reliable. and reproducible test to evaluate most of the biliary treeDifferentiates patients with medical jaundice front those with surgical jaundiceHigh specificity and sensitivity for gallstones.) superior to CT)CELTCT can be used to identify the cause and site of biliary obstructionTriple-phase CT (Arterial phase. Portal venous phase, and Delayed phase) is invaluable in preoperative planning.Magnetic resonance imagingIt uses the water in bile to delineate the biliary tree and thus provides superior anatomic definition of the intrahepatic and extrahepatic biliary tree and pancreas.MRI is noninvasive, requires no radiation exposure, and can prove extremely useful when planning resection of biliary or pancreatic neoplasms or management of complex biliary pathology.By using the water content of bile, a cholangiopancreatogramtMRCP) can becreatedEndoscopic retrograde cholangiopancreatography (ERCP)Endoscopic retrograde cholangiopancreatography is an invasive test using endoscopy and fluoroscopy to inject contrast through the ampulla and image the biliary tree.In general ERCP is done when a therapeutic intervention is planned (Stone extraction in CBD stones/stenting for strictures) and not as a standalone diagnostic procedure.Percutaneous transhepatic cholangiography (PTC)It is an invasive procedure used to evaluate the biliary tree.Intrahepatic biliary radical dilatation is a prerequisite for performing PTC.A needle is passed directly into the liver to access one of the biliary radicals, and the tract is then used for insertion of transhepatic catheters.Useful for patients with intrahepatic biliary disease or in whom ERCP is not technically feasiblePTC can decompress biliary obstruction, stent obstructions nonoperatively, and provide anatomic information for biliary reconstruction
CT Abdomen
ERCP
MRCP
USG
Bile Duct Injury and Stricture