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Ictericiauqi
- 16. UTILIDAD DE LAS IMÁGENES estudio sensibil especific morbilid mortalid US 55-91% 93-100% 0 0 TAC 63-96% 93-100% 0 0 CPC 98-100% 89-100% 3% 0.2% CPRE 89-98% 89-100% 3% 0.2%
- 17. ULTRASONIDO EN ICTERICIA cálculo lodo
- 18. TAC EN ICTERICIA
- 19. RMN EN ICTERICIA
- 24. ALGORITMO DX ICTERICIA (Up to Date 03) Historia clínica, BH, PFH Fa, tgp, ¿normales? SI: hemólisis, hereditaria NO: ¿parece obstrucción? SI POSIBLE NO Buscar hepatitis hasta bx CB dilatados US-----TAC CB normales TRATAR OBSTRUCCIÓN CPRE CPC CB NORMALES OBSERVACIÓN CONSIDERE Bx SI POSIBLE NO
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- Figure 9-1. Several noninvasive imaging modalities are currently available. Selection of the most appropriate technique requires knowledge of the sensitivities and limitations of each study. Ultrasonography has a sensitivity for detection of common bile duct stones ranging from 10% to 81%, whereas computed tomography (CT) has a sensitivity of 50% to 90%. The data for magnetic resonance cholangiopancreatography are not yet available. Intravenous cholangiography and nuclear scintigraphy do not have well defined roles in the diagnosis and management of patients with known or suspected choledocholithiasis. This ultrasonogram shows common bile duct dilatation, echogenic sludge, and a common bile duct stone with acoustic shadowing present distally. Although ultrasonography is the preferred modality for diagnosing suspected cholelithiasis, it is relatively insensitive with respect to documentation of stones in the common bile duct.
- Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B, Courtesy of Robert Whitlock, New York, NY.)
- Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B, Courtesy of Robert Whitlock, New York, NY.)
- Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B, Courtesy of Robert Whitlock, New York, NY.)
- Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.
- Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.