JAUNDICE Ultrasound Obstructive Hepatocellular. Obstructive Jaundice Gallstones Pancreatic Cancer Cholangiocarcinoma Ampullary tumour Benign Biliary stricture.

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.

NHS TRUST CEO COUNCILLING