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* ercp mrcp hida ct us
 #858629  
  study098 - 07/02/19 15:28
 
  If anyone else is confused too.

http://www.usmleforum.com/files/forum/2013/5/734354.php

*
First for any GB related pathology USG is the best DX of choice.

Pancreas related pathology. CT scan .

Now when gall stone is in the cystic duct , it causes acute cystitis. No elevation of liver enzymes. No jaundice. Only pain in RUQ etc- DX - USG.

Gall stone going further in CBD and it passes through CBD causing Biliary colic . This cloud pain is actually misnomer as it is actually a persistent pain but should nit last for more than 12 hours.

When it does for more than 12 hours , it is likely obstructing the CBD , causing pain and obstructive jaundice. So painful obstructive jaundice. Now it the obstruction is persistent, it will eventually cause infection , leading to ascending cholangitis. So u get pain, fever and jaundice and that is the Charcoat's triad . So you begin with USG and look at CBD diameter whose normal value is 6 mm. When it is mode than 10 mm , it is likely that there is CBD stone. So you do ERCP for confirmation as well as for Rx with stent etc. Now if the patient is really sick with shock etc , you might just do percutaneous drainage in stead of ERCP as pt is too unstable to take him to OT. Now in case, CBD diameter in USG is less than 10 , so unlikely CBD obstruction, so u first do MRCP. If that's positive for stone do ERCP. So in a low probability case, do MRCP first and then ERCP if MRCP is positive. For high probability case, do ERCP first. Something like D diner for low probability DVT/PE.

Now when jaundice but painless, likely not due to stone. Most likely ca pancreas. So do CT scan first. After CT , do pancreatic MRI protocol to find the extend of tumor and manage accordingly. Whipples or chemotherapy or ERCP in liver mets etc.

When case is highly suspected for cholecystitis , but USG non confirmatory, do HIDA scan. Non visualization of Gb is diagnostic. False positive HIDA in advanced liver damage and TPN.

Acute epigastric pain, amylase , lipase elevated, again CT abdomen.

Courtesy: Archer as far as I remember.

Hope it helps a little bit. *

 
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* Re:ercp mrcp hida ct us
#3382758
  amnaali - 07/03/19 12:57
 
  Nice, thanks  
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