Ultrasound Obstructive Hepatocellular 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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