IMAGING THE HPB SYSTEM

Question 1

Which is the more useful imaging technique for lesions of the gall bladder and bile duct?

Answer 1

USS

Question 2

In what cases might we use endoscopic ultrasound in HPB pathology?

Answer 2

Detect and stage pancreatic cancer

Assess bile ducts

Confirm malignancy with US guide fine needle aspiration

Tube placement to drain pancreatic fluid collection

Question 3

What is the most sensitive imaging modality for liver disease?

Answer 3

MRI

Question 4

What is the non-invasive technique used to produce high quality images of the pancreatic and bile ducts?

Answer 4

MRCP - Magnetic Resonance Cholangiopancreatography

Question 5

When is ERCP used instead of MRCP?

Answer 5

When therapeutic intervention is required. ERCP allows us to remove stones and place stents to relieve obstruction caused by strictures.

Question 6

What are the possible complications of ERCP?

Answer 6

Bleeding after cutting the sphincter to aid bile duct cannulation or stone removal

Acute pancreatitis

Perforation

Cholangitis

Question 7

What is percutaneous transhepatic cholangiopancreatography (PTC) and when might you use it?

Answer 7

This technique involves injection of contrast into the biliary system via percutaneous needle inserted into intrahepatic duct.

Performed in those in whom ERCP has failed or is not possible.

Question 8

What are the contraindications to percutaneous liver biopsy?

Answer 8

Prolonged prothrombin time

Platelet count of less than 50

Extrahepatic cholestasis

Suspected haemangioma