Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Gastroenterology


Answer 4
  1. Endoscopic ultrasound. The likelihood that this patient has CBD stones is low because she does not have gallstones in her resected gallbladder and her laboratory test results are normal during episodes of pain. Invasive methods to evaluate the biliary tree, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography, thus would not be warranted. CT scan is often insensitive when looking at the biliary tree for stones or sludge. Magnetic resonance cholangiography can offer good images of the biliary system and can identify bile duct stones, but endoscopic ultrasound is regarded as superior when looking for focal bile duct stones as well as microlithiasis (ie, biliary sludge), which also could be causing this patient’s symptoms.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj