Ramu, presents with recurrent attacks of cholelithiasis, U/S examination shows a dilated CBD of 1 cm. The next line of management is :
Ans. is 'a' ie. ERCP (Ref. Schwartz, 7/e, p 1443)The first inv. for any pt. with cholelithiasis or jaundice is U/S.Next inv. depends on U/S findings,If the intrahepatic ducts are dilated without any extrahepatic dilatation then the preferred inv. is - PTC* If the dilatation is in CBD - ERCP*.ERCP may provide direct diagnosis of the distal CBD pathology and may be therapeutic as well for a CBD stone or stricture.
ERCP
PTC
Cholecystostomy
Intravenous cholangiogram
Gallstone Disease