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JAUNDICE

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.

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JAUNDICE

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  1. JAUNDICE Ultrasound Obstructive Hepatocellular

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

  3. 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.

  4. 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.

  5. Benign Stricture • Be sure of the diagnosis- CT, MRCP, Bx, Cytology, EUS. • Sphincterotomy • Balloon sphincteroplasty • Plastic Stent • Covered Metal Stent • Surgical reconstruction

  6. 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.

  7. NHS TRUST CEO COUNCILLING

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