1. Imaging the Bilary Tree

2. Ultrasound

3. Pros and Cons Cost- $100 90-95% accurate Good for detecting billary duct dilatation, cholelithiasis, gallbladder wall thickness and the presence of pericholecystic fluid. Not good for choledocholithiasis.

4. Plain Abdo X-ray

5. Pros and Cons Cost- $30 Sensitivity is only 15% for stones Doesn’t show the bilary tree

6. ERCP (Endoscopic Retrograde Cholecysto Pancreatography)

7. Pros and Cons Cost- $300+theatre fees+equipment Allows diagnosis and treatment Requires anaesthesia Complications ▫Mortality rate of 1% ▫Pancreatitis ▫Bleeding ▫Duodenal perforation

8. IV Cholangiography +/- CT

9. Pros and Cons Cost- $400 Provides detailed images of the anatomy and is very sensitive for detecting choledocholithiasis. Need to have bilirubin <40 so the liver can excrete the contrast into the bilary tree. The contrast can cause allergic reactions Not as good as ultrasound as detecting cholelithiasis

10. HIDA Scan

11. Pros and Cons Cost- $400 Doesn’t give a detailed image of the bilary tree Provides an assessment of gallbladder function. Useful to diagnose cholecystitis when ultrasound isn’t clear and is also useful for bile duct leaks and common bile duct obstructions.

12. MRI

13. Pros and Cons Cost- $400 Contraindicated in pts with pacemakers, intracerebral metal clips or metal shards in their eyes. Good imaging of the bilary tree and stones

14. PTC (Percutaneous Transhepatic Cholangiography)

15. Pros and Cons Cost- $180 for the x ray, $400 for the procedururist and the costs of anaesthesia and admission. Complications ▫Bleeding ▫Bile leak Good when ERCP can’t be performed Also good when there is a complete obstruction of the bilary tree and you wish to visualise the proximal tree.