Learning objectives
Know the place of imaging techniques in the exploration of cholestatic jaundice.
Discuss the main causes of jaundice in adults according to the seat of the obstruction on the biliary tract.
Describe iconographic aspects of the main etiologies of jaundice in adults.
Background
Cholestatic jaundice is a condition in which there is a blockage in the flow of bile movement from the liver to the duodenum.
The two basic distinctions are: intrahepatic biliary stasis (hepatocellular jaundice) and mechanical biliary obstruction,
bearing in mind that several intrahepatic causes of cholestatic jaundice can mimic extrahepatic obstruction to varying degree.
Ultrasound is the first imaging modality used in the algorithm for the investigation of cholestatic jaundice.
Further imaging depends on whether the bile ducts are dilated.
If the bile ducts are...
Findings and procedure details
Imaging Methods
The methods used in evaluating the jaundiced patient currently include ultrasound (US),
computed tomography (CT),
magnetic resonance cholangiopancreatography (MRCP),
endoscopic retrograde cholangiopancreatography (ERCP),
and endoscopic US (EUS).
Ultrasound
US is the initial imaging test of choice in jaundiced patients because it is non-invasive,
inexpensive and readily available.
US is used to determine the presence of obstructive jaundice by depicting dilated bile ducts,
with sensitivity of 55% to 95% and specificity of 71% to 96%.
False-negative studies are due to 2 factors: inability to...
Conclusion
Ultrasound is a useful initial investigation of cholestatic jaundice because it is non-invasive and assesses pancreaticobiliary structures in real-time without exposing the patient to ionising radiation.
CT and MRCP are performed second line.
References
[1] American College of Radiology.
ACR Appropriateness Criteria Jaundice.Journal of the American College of Radiology,
06/2013; 10(6): 402–409.[http://dx.doi.org/10.1016/j.jacr.2013.02.020]
[2] Department of Health Western Australia - Diagnostic Imaging Pathways – Cholestatic Jaundice,
01 December 2011 - Publisher: Department of Health Western Australia.
[3] Bipat S,
Phoa SS,
van Delden OM et al.
Ultrasonography,
computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis.
Journal of computer assisted tomography 2005 Jul-Aug;29(4):438-445.
[4] Tongdee T,
Amornvittayachan O,
Tongdee R.
Accuracy of multidetector...