A patient has a surgical cause of obstructive jaundice. USG can tell all of the following except:
Ans. b. Peritoneal deposits (Ref: Sabiston 19/e p1481: Schwartz 9/e p1140; Bailey 25/e p 1113-1114, Blumgart 5/e p223: Schackelford 7/e p1303)Peritoneal deposits are not detected by ultrasound. Even CECT can miss the peritoneal deposits.Best investigation for diagnosis of peritoneal deposits is diagnostic laparoscopy.Ultrasound:Initial imaging modality of choice in obstructive jaundiceQIt can identify intra- and extrahepatic biliary dilatationQAscites can be detected by ultrasound.USG is IOC for acute calculous cholecystitis, chronic cholecystitis and cholilithiasisUltrasonographyInitial imaging modality of choice in obstructive jaundiceQIt is operator dependent and maybe suboptimal due to excessive body fat and intraluminal bowel gasQ.USG can demonstrate* Size of GB and CBDQ* Thickness of GB wallQ* Presence of inflammationQ around GB* Biliary calculiQ* Occasionally, presence of stones within the biliary treeQ.It may even show a carcinoma of the pancreas occluding the CBDQ.USG in obstructive jaundiceInitial imaging modality of choice in obstructive jaundiceQIt can identify intra- and extrahepatic biliary dilatationQIdentify the level of obstructionQCause of the obstructionQ may also be identified (gallstones in the gall bladder, common hepatic or CBD stones or lesions in the wall of the duct suggestive of a cholangiocarcinoma or enlargement of the pancreatic head indicative of a pancreatic carcinoma)Q
Biliary tree obstruction
Peritoneal deposits
Gall bladder stones
Ascites
Gall Bladder & Bile Ducts