Cholangitis other imaging findings: Difference between revisions
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{{Cholangitis}} | {{Cholangitis}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{FH}} | ||
==Overview== | |||
[[Magnetic resonance cholangiopancreatography]] (MRCP) and [[endoscopic sonography]] (EUS) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis. [[Endoscopic retrograde cholangiopancreatography]] (ERCP) is also considered a gold standard test for biliary obstruction. | |||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
===Endoscopic Retrograde Cholangiopancreatography (ERCP)=== | ===Endoscopic Retrograde Cholangiopancreatography (ERCP)=== | ||
* It is the best method available as it is both diagnostic and therapeutic | * It is the best method available as it is both diagnostic and therapeutic. | ||
* | *It involves the use of [[endoscopy]] to pass a small [[cannula]] into the [[bile duct]]. | ||
* | **Radiocontrast is then injected to opacify the duct, and X-rays are taken to get a visual impression of the [[biliary system]]. | ||
*On the endoscopic image of the [[ampulla]], one can sometimes see a protuberant ampulla from an impacted [[gallstone]] in the [[common bile duct]], or the frank extrusion of pus from the common bile duct orifice.<ref name="efg123"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016</ref> | |||
For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable; however, if the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct. <ref name="efg123"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016</ref> | |||
===Magnetic Resonance Cholangiopancreatography (MRCP)=== | ===Magnetic Resonance Cholangiopancreatography (MRCP)=== | ||
* Useful in patients with postcholecystectomy and in patients with non-conclusive ERCP | *Useful in patients with [[postcholecystectomy]] and in patients with non-conclusive ERCP.<ref name="pmid16691174">{{cite journal |vauthors=Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM |title=[Acute cholangitis: imaging diagnosis and management] |language=French |journal=J Radiol |volume=87 |issue=4 Pt 2 |pages=430–40 |year=2006 |pmid=16691174 |doi= |url=}}</ref> | ||
*The only disadvantage is that smaller stones can be missed on a MRCP.<ref name="efg123"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016</ref> | |||
==References== | ==References== | ||
Revision as of 20:40, 15 April 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]
Overview
Magnetic resonance cholangiopancreatography (MRCP) and endoscopic sonography (EUS) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) is also considered a gold standard test for biliary obstruction.
Other Imaging Findings
Endoscopic Retrograde Cholangiopancreatography (ERCP)
- It is the best method available as it is both diagnostic and therapeutic.
- It involves the use of endoscopy to pass a small cannula into the bile duct.
- Radiocontrast is then injected to opacify the duct, and X-rays are taken to get a visual impression of the biliary system.
- On the endoscopic image of the ampulla, one can sometimes see a protuberant ampulla from an impacted gallstone in the common bile duct, or the frank extrusion of pus from the common bile duct orifice.[1]
For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable; however, if the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct. [1]
Magnetic Resonance Cholangiopancreatography (MRCP)
- Useful in patients with postcholecystectomy and in patients with non-conclusive ERCP.[2]
- The only disadvantage is that smaller stones can be missed on a MRCP.[1]
References
- ↑ 1.0 1.1 1.2 Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016
- ↑ Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM (2006). "[Acute cholangitis: imaging diagnosis and management]". J Radiol (in French). 87 (4 Pt 2): 430–40. PMID 16691174.