Diagnostic studies choledocholithiasis

chole docho lithiasis

膽 總 石 炎

(J Hepatol 2016;65:146; Gastrointest Endosc 2019;89:1075)

詳見EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones

• Labs: ↑ bilirubin, Aϕ; transient spike in ALT or amylase suggests passage of stone

• RUQ U/S: BD stones seen ~50–80% of cases; usually inferred from dilated CBD (>6 mm)

ERCP preferred modality

• when likelihood high of diagnostic studies choledocholithiasis

cholangiogram (percutaneous, operative)

if ERCP unavailable or unsuccessful; EUS/MRCP to exclude BD stones if suspicion intermediate (eg, no stone, dilated ducts on U/S, bili 1.8–4 mg/dL, gallstone panc., age >55, or abnl non-bili LFT)