JAUNDICE

Ultrasound

Obstructive Hepatocellular

Obstructive Jaundice• Gallstones• Pancreatic Cancer• Cholangiocarcinoma• Ampullary tumour• Benign Biliary stricture• Metastatic-Liver, Portal• Primary sclerosing cholangitis• IgG 4 disease• Surgical trauma

ERCP or PTC

• ERCP is preferable- less traumatic, better tolerated.

• Failed ERCP- why?- Patient tolerance, Anatomical, Pathology, Post-surgical, Unable to cross obstruction.

• Repeat ERCP- with or without Combined, GA.• PTC- with or without combined.

Ductal Stones

• Be sure of the diagnosis- ERCP should rarely be used as a diagnostic test.

• Adequate Esx.• Balloon clearance, Basket, Lithotripter, Plastic

Stent.• Always achieve drainage.

Benign Stricture

• Be sure of the diagnosis- CT, MRCP, Bx, Cytology, EUS.

• Sphincterotomy• Balloon sphincteroplasty• Plastic Stent• Covered Metal Stent• Surgical reconstruction

Malignant Stricture

• Be sure of the diagnosis.• Plastic stent, simple, rarely fails, cheap,

removable, Bridge to Surgery, short prognosis.• Expanding Metal Stent- Uncovered, Covered.• Multiple stents, Stent within Stent.• Surgical Resection, Palliative bypass.

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