![\"DISORDERS](\"http:\/\/liverandpancreasclinic.com\/blog\/wp-content\/uploads\/2018\/01\/liver-gall-bladder-or-pancreatic-problem-300x227.jpg\")
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When a patient is suspected or diagnosed with a\u00a0liver, gall bladder or pancreatic problem, a whole\u00a0list of investigations are asked quite often,\u00a0confusing the patient and the family regarding the\u00a0reason behind so many expensive investigations, especially when it becomes difficult to give a\u00a0certain answer after they are done or they are
\nrepeated at intervals or because the previous\u00a0investigation was apparently suboptimal. This is\u00a0a frequent scenario when a patient comes with a\u00a0liver tumor of uncertain nature or patient with\u00a0suspicious tumor in pancreas or chronic
\npancreatitis with cyst.<\/p>\n
This list can go on but what is important is that\u00a0patient and relatives should know why a\u00a0particular test is asked, what is the nature of test\u00a0and why more tests may be needed or tests may\u00a0have to be repeated. The following information is\u00a0aimed at solving this issue to a reasonable extent.\u00a0However they do not include tests that are done\u00a0for a very specific individual disease. The\u00a0common tests include<\/p>\n
These are simple blood tests done to assess whether\u00a0the liver is functioning normally in any situation.
\nThese include level in the blood of bilirubin (total,\u00a0direct & indirect), protein (total protein and fractions
\nlike albumin & globulin), liver enzymes (SGOT,\u00a0SGPT, Alkaline Phosphatase, GGTP), & blood\u00a0clotting (prothrombin time &INR).<\/p>\n
In a patient with liver, biliary & pancreatic problem\u00a0these tests develop changes depending on underlying
\ndisease. Most often they indicate the diagnosis before\u00a0imaging changes take place. A careful assessment of
\nthese tests together with the clinical picture can give\u00a0the possible diagnosis & help in treatment planning.
\nThese may be repeated frequently during the course\u00a0of disease to follow the recovery. Therefore these
\ntests are important part of your disease work up.<\/p>\n
Preferably they should be performed on empty\u00a0stomach, however when a patient comes with acute
\nproblem these tests may have to be done in\u00a0emergency also.<\/p>\n
These are substances that show up in the blood when\u00a0a particular tumor occurs in the body and are\u00a0produced by the tumor cells. These indicate presence\u00a0of tumor on simple blood test. The test very often but\u00a0not always clinches the diagnoses because sometimes\u00a0the levels can go up in noncancerous situations. Else\u00a0the levels can remain normal in the presence of tumor.\u00a0For liver, biliary & pancreatic cancers these include\u00a0Alpha Fetoprotein (AFP), CA19.9, and\u00a0CarcinoEmbryonic Antigen (CEA).<\/p>\n
This is a simple, painless and relatively quick\u00a0investigation, which can be used to obtain a \u2018picture\u2019\u00a0of the inside of the abdomen. Pictures are made using\u00a0harmless sound waves & are safe even in pregnant\u00a0patient. These waves bounce off interfaces between\u00a0dense and less dense structures. The sound waves will\u00a0not cross solid areas (such as bone) or areas\u00a0containing air or other gas. Usually only a fairly simple picture of the pancreas, liver, bile ducts and\u00a0gallbladder can be obtained.<\/p>\n
Avoid eating for 6-8 hours prior to the test, as any\u00a0fluid or food, which is taken by mouth can obscure\u00a0the pictures especially visualization of gall bladder &\u00a0pancreas. The test is performed while you lie fully\u00a0awake on a simple couch. A special jelly is used to\u00a0enable the \u2018probe\u2019, which produces and collects the\u00a0sound waves, to be moved over the skin of the\u00a0abdomen. The radiologist moves the probe around\u00a0and simultaneously examines the images on a TV
\nscreen.<\/p>\n
USG gives excellent information about gall bladder &\u00a0liver pathologies. However, it has its own limitations\u00a0in\u00a0 diagnosing intraabdominal problems of pancreas\u00a0and lower portion of the bile duct because these\u00a0structures are\u00a0 quite often hidden behind gas in the\u00a0overlying intestine. It is also dependent on the person\u00a0doing the examination.\u00a0 Hence one may need more\u00a0sophisticated investigations even if USG is normal\u00a0and certainly when USG shows\u00a0 pathology. However\u00a0gall bladder problems like stones do not necessarily\u00a0require more investigation. Sometimes USG\u00a0 itself is\u00a0repeated and done on better machine with more\u00a0experienced person given its lower cost compared to\u00a0other investigations.<\/p>\n
A CT scan uses X-rays, which are emitted and\u00a0collected through 360 degree. It produces excellent\u00a0pictures of the liver, gall bladder, pancreas and other\u00a0abdominal structures but not the bile duct.<\/p>\n
A normal blood creatinin level is required to undergo\u00a0a contrast CT scan study, so you would be asked toshow this\u00a0 report at the time of CT scan.<\/p>\n
You need to avoid eating for 6-8 hours beforehand\u00a0and is performed while you are fully awake. You lie\u00a0on a special couch attached to the CT scanner, which\u00a0looks like a large \u2018doughnut\u2019. The couch is made to\u00a0move through the\u00a0 doughnut as the X-rays are then put\u00a0together by a computer to produce the pictures at\u00a0different levels of the\u00a0 abdomen. In order to make it\u00a0easier to interpret the structures in the abdomen, you\u00a0will be asked to swallow a liquid (\u2018contrast\u2019). This\u00a0fills the stomach and the intestines. Another injection\u00a0of a different contrast (\u2018dye\u2019) is given into a vein\u00a0(usually in the arm) during the second half of the\u00a0procedure. This helps to show up the blood vessels,\u00a0nature of tissue and characterization of lesions. If you\u00a0are allergic to iodine or have asthma you could have a\u00a0serious reaction to the injection, so it’s important to let\u00a0your doctor know beforehand.<\/p>\n
The results may be explained to you or a relative in\u00a0the ward but the best time to discuss the findings is at\u00a0the next outpatient visit or the next day in the ward.<\/p>\n
It is vital that a triple phase study is performed when a\u00a0CT scan is done for liver and pancreatic problem. A\u00a0triple phase study provides information about these\u00a0organs when no contrast is given, when contrast is\u00a0flowing through the arteries and then veins of these\u00a0organs and lastly when contrast has exited these\u00a0organs altogether.<\/p>\n
At many centers this protocol is not followed as they\u00a0are not specialized units doing liver and pancreatic\u00a0work and then it becomes difficult for your surgeon to\u00a0come to a decision regarding diagnosis and treatment.\u00a0In this situation a repeat study at the specialized\u00a0center is asked for. Also often there is a significant\u00a0time gap between the 1st study and the time when a\u00a0specialist actually gets to see you. At such times\u00a0repeating the CT scan is the only option to know the
\ncurrent status of the disease.<\/p>\n
An MRI scan is similar to a CT scan but uses\u00a0magnetic field to image the liver, pancreas & biliary\u00a0tract instead of
\nX-rays. Very powerful magnets are\u00a0used to generate the pictures. For this reason, patients\u00a0that have certain metal parts inside their bodies (that\u00a0can respond to the magnet) must not have this procedure.<\/p>\n
Most modern appliances introduced into patients,\u00a0such as clips during open surgery or a heart valve\u00a0with metal parts, are made of material which cannot\u00a0respond to the magnet and are therefore safe. As a\u00a0precaution you must tell your doctors if you have any\u00a0such appliances in your body to let them decide.<\/p>\n
MRI scans have the advantage that no X-rays are\u00a0emitted and therefore are particularly suited to\u00a0patients who need to have many such tests. The type\u00a0of pictures produced by MRI however is not the same\u00a0as CT and the decision of which to use and when to\u00a0use them will rest with your doctor.<\/p>\n
Some people are given an injection (gadolinium) of\u00a0dye into a vein in the arm. This is called a contrast\u00a0medium and can help the images from the scan to\u00a0show up more clearly.<\/p>\n
During the test you will be asked to lie very still on a\u00a0couch inside a long cylinder (tube) for about 30\u00a0minutes. It’s painless but can be slightly\u00a0uncomfortable, and some people feel a bit\u00a0claustrophobic during the scan. It\u2019s also noisy, but\u00a0you\u2019ll be given earplugs or headphones. You will be\u00a0able to hear, and speak to, the person operating the\u00a0scanner.<\/p>\n
MRI can also be used to provide very good pictures of\u00a0the bile ducts and pancreatic ducts. This procedure is\u00a0called MRCP<\/strong>, which is short for Magnetic Resonance\u00a0Cholangio-Pancreatography. MRCP has practically\u00a0replaced ERCP as a diagnostic modality for\u00a0pancreatobiliary problems.<\/p>\n This is a special investigation for taking pictures of\u00a0the bile and pancreatic ducts and is mainly used for\u00a0treatment of bile duct and pancreatic duct\u00a0problems<\/strong>. It can also be used to unblock the bile duct\u00a0if necessary.<\/p>\n Do not eat or drink anything for at least 8 hours\u00a0before the test. Usually a plastic tube is put into a vein\u00a0of the right forearm or the back of the hand before\u00a0you go to the endoscopy department. You may need a\u00a0drip of intravenous fluids and be given one or more\u00a0antibiotics in the drip. You will be asked to sign a\u00a0consent form after explaining the procedure &\u00a0possible complications, agreeing to this procedure\u00a0because complications can occur.<\/p>\n You are taken on a trolley to the endoscopy\u00a0department and, after being checked by a nurse, asked\u00a0to move onto the X-ray table. You will be asked to lie\u00a0on your left side with your left arm behind your back\u00a0and be given a throat spray of local anesthetic. This\u00a0tastes awful but the feeling quickly goes and it will\u00a0stop any coughing during the procedure. A second\u00a0spray may then be given under the tongue, which\u00a0contains a substance to help the ampulla of Vater\u00a0open up during the procedure. A strong sedative is\u00a0now given by injection. This is enough to make most\u00a0patients very sleepy but not fully unconscious. It is\u00a0very important that you are as relaxed as possible\u00a0before and during the\u00a0 procedure.<\/p>\n It involves inserting a flexible tube or endoscope (also\u00a0called a duodenoscope) into the mouth. This is passed\u00a0down the gullet and into the stomach and then into the\u00a0initial part of small intestine called duodenum. There\u00a0is then a strange sensation as air is introduced into the\u00a0stomach. Belching should be avoided as the air helps\u00a0the endoscopist to pass the tip of the telescope into the\u00a0duodenum. Most patients usually do not remember\u00a0anything of the procedure.<\/p>\n In duodenum endoscope is positioned opposite the\u00a0opening of the bile duct and pancreatic duct (ampulla\u00a0of Vater). A small tube (cannula) is then pushed into\u00a0the opening of ampulla of Vater and contrast (\u2018dye\u2019)\u00a0is injected into the ducts. You lie on an X-ray table to\u00a0enable pictures of the ducts to be taken while the contrast is injected.<\/p>\n To treat bile duct or pancreatic problems by this\u00a0means, it is common to cut the sphincter of Oddi\u00a0using a small electric current on the tip of the cannula.\u00a0This procedure cutting the sphincter is called a\u00a0sphincterotomy. Because it is performed using an\u00a0endoscope its full name is endoscopic\u00a0sphincterotomy. By cutting the sphincter it makes it Sometimes it is necessary to insert a temporary\u00a0(plastic) or permanent (metal mesh) tube into the bile\u00a0duct to keep a good flow of bile. These tubes are\u00a0called stents<\/strong> \u2013 after Dr Stent who first used these\u00a0small tubes. Stents or temporary tubes (also called a\u00a0cannula) may also be inserted into the main pancreatic duct.<\/p>\n tweezers (called forceps). This small piece of tissue is\u00a0called a biopsy and is checked by histology. This\u00a0procedure is therefore called endoscopic biopsy<\/strong>. A\u00a0small brush may also be used to brush the sidewalls of\u00a0the bile duct or\u00a0 pancreatic duct to obtain small cells\u00a0that can be checked by cytology. This procedure is\u00a0therefore called brush cytology<\/strong>.<\/p>\n Sometimes a small endoscope (baby) may be\u00a0introduced through the main endoscope channels\u00a0(mother scope). This baby scope can enter bile duct\u00a0for spying on the pathologies, which are sometimes\u00a0not visible (spy glass) or can enter pancreatic duct for\u00a0a very close distance ultrasonography (IntraDuctal\u00a0UltraSound — IDUS)<\/p>\n The results may be explained to you or a relative on\u00a0the ward but it can take time to receive the results of\u00a0histology or biopsy. If you have been treated mainly\u00a0as an outpatient, then the best time to discuss the\u00a0findings and any rocedures is at the next outpatient visit or the next day on the ward. The results are not\u00a0always easy to interpret and are usually combined\u00a0with other tests to provide an overall diagnosis.<\/p>\n It is always necessary for a friend or relative to drive\u00a0you home if you have had an ERCP as an out-patient\u00a0because it takes several hours for the effects of the\u00a0drugs to wear off.<\/p>\n ERCP is safe with no complications in about 95% of\u00a0cases. There are occasionally complications from\u00a0ERCP however even in experienced hands, the most\u00a0common of which are acute pancreatitis, biliary\u00a0infection, and bleeding & duodenal perforation.<\/p>\n If the procedure was planned as a day case procedure,\u00a0it will be necessary to keep you in hospital overnight\u00a0if there has been a complication. In most cases, the\u00a0complications improve, and patients are soon\u00a0discharged. Very occasionally the complication is\u00a0serious and death may result in a very small\u00a0proportion of cases.<\/p>\n For patients that are having ERCP for treatment (such\u00a0as having a stent or having a gallstone removed)\u00a0special precautions are taken to reduce the risk. These\u00a0precautions usually include having a drip running in\u00a0extra fluid into an arm or neck vein, antibiotics and a\u00a0bladder tube (urinary catheter) and urinary collecting\u00a0bag to make sure that the kidneys (which make the\u00a0urine) are working properly.<\/p>\n Sometimes it is not possible to approach the bile duct\u00a0or to enter the bile duct using an endoscope. In this\u00a0situation it may be necessary to insert a very fine\u00a0needle into the bile duct by going first through the\u00a0skin on the right side and then finding a branch of the\u00a0main bile duct within the liver. Therefore the full\u00a0name of this procedure is Percutaneous Trans Hepatic\u00a0Cholangiography and is always performed in the Xray\u00a0department. Pictures of the bile ducts are taken\u00a0after injecting some \u2018dye\u2019 or contrast.<\/p>\n PTHC can be used to provide temporary or permanent\u00a0(stent) drainage of bile, remove gallstones from the\u00a0bile duct, perform brush cytology and insert a biliary\u00a0stent, which may be either plastic or metal (PTBD).<\/p>\n Do not eat or drink anything for at least 6 hours\u00a0before the test. Usually a plastic tube is put into a vein\u00a0of the right forearm or the back of the hand before\u00a0you go to the radiology department. You may need a\u00a0drip of intravenous fluids and be given one or more\u00a0antibiotics in the drip. You will be asked to sign a\u00a0consent form after explaining the procedure &\u00a0possible complications, agreeing to this procedure\u00a0because complications can occur.<\/p>\n PTHC is usually done under X ray guidance. You are\u00a0made to lie on your back on a special x-ray\u00a0compatible table. The procedure is done using sterile\u00a0procedures, so the skin is cleaned with an antiseptic\u00a0and special gown are used. Before the needle is\u00a0passed local anesthetic is injected into the skin. The\u00a0needle may need to be passed between the lower ribs\u00a0on the right hand side but this is quite safe.<\/p>\n In difficult situations both PTHC and ERCP are\u00a0performed together \u2013 one technique makes it easier\u00a0for the other technique to be successful. When both\u00a0techniques are used together it is known as a\u00a0combined procedure or\u00a0 rendezvous procedure. PTHC requires additional informed, written consent.<\/p>\n PTHC is safe with no complications in about 95% of\u00a0cases. There are occasionally complications from\u00a0PTHC however, the most common of which are\u00a0abdominal pain, biliary infection, bleeding and a bile\u00a0collection or abscess. In most cases, the complications\u00a0improve with medical management. But occasionally\u00a0a surgery may be required to tackle the complication.\u00a0Occasionally the complication is serious and death\u00a0may result in a very small proportion of cases.<\/p>\n Special precautions are taken before the procedure is\u00a0performed to reduce the risk. These include a drip of This procedure is only performed if it is really\u00a0necessary and is only performed in specialist centers.<\/p>\n This is a special investigation for taking ultrasound\u00a0pictures of the pancreas, pancreatic and bile ducts,\u00a0gall bladder and surrounding tissue such as blood\u00a0vessels at close distance. A special probe inserted into\u00a0the stomach and duodenum takes the pictures.\u00a0Because the ultrasound probe is much closer to the\u00a0pancreatobiliary tree, EUS can provide pictures that\u00a0are much clearer than the usual percutaneous\u00a0ultrasound scan.<\/p>\n EUS is performed using special flexible endoscope\u00a0with an ultrasound probe at its tip. It is passed into the\u00a0mouth, down the gullet and into the stomach. At this\u00a0point the ultrasound probe is switched on and the\u00a0pancreas can be seen through the stomach wall. The\u00a0pictures are displayed on a television screen and\u00a0copies of the images can be made. The telescope is\u00a0then passed into the duodenum to obtain different\u00a0views of the pancreas and also of the bile ducts, You do not eat or drink anything for at least 8 hours\u00a0before the test. The procedure is done on a flat couch\u00a0under sedation. You will be asked to sign a consent\u00a0form agreeing to this procedure because\u00a0complications can occur. Normally you are taken on a\u00a0trolley to the endoscopy department and, after being\u00a0checked by a nurse, asked to move onto the flat\u00a0couch. You will be asked to lie on your left side with\u00a0your left arm behind your back and be given a throat\u00a0spray of local anesthetic. This tastes awful but the\u00a0feeling quickly goes and it will stop any coughing\u00a0during the procedure. At this stage you are given a\u00a0strong sedative by injection. This is enough to make\u00a0most patients very\u00a0 sleepy but not fully unconscious. It\u00a0is very important that you are as relaxed as possible\u00a0before and during the procedure.<\/p>\n The telescope is easily passed into the mouth and\u00a0stomach. There is then a strange sensation as air is\u00a0introduced into the stomach. Belching should be\u00a0avoided as the air helps the endoscopist to pass the tip\u00a0of the telescope into the duodenum. Most patients\u00a0usually do not remember anything of the procedure.<\/p>\n EUS may be used to remove small cells using a small\u00a0needle inserted into a suspicious area. Cells are drawn\u00a0up a small tube (or cannula) using a small syringe.\u00a0This procedure is therefore called EUS aspiration\u00a0cytology<\/strong>. EUS is also used on occasions to guide\u00a0therapeutic procedures like aspiration or drainage of\u00a0cyst of pancreas or drainage of bile duct when a\u00a0conventional sphincterotomy is not possible for\u00a0various technical reasons.<\/p>\n A patient can have liquids immediately after a\u00a0diagnostic EUS if no anesthetic is used, after 2 hours\u00a0if an anesthetic is used. If a therapeutic procedure is\u00a0done a minimum of starvation of 6 hours after the\u00a0procedure is required, however the ideal time will\u00a0depend on the procedure & post procedure recovery,\u00a0and should be decided by the person who has done\u00a0EUS. It is usually necessary to admit the patient if a\u00a0therapeutic procedure is performed.<\/p>\n The results of EUS may be explained to you or a\u00a0relative in the ward but the best time to discuss the\u00a0findings is at the next outpatient visit or the next day\u00a0in the ward. The results of cytology are often not easy\u00a0to interpret and may take a while for them to become\u00a0available. The results are usually combined with other\u00a0tests to provide an overall diagnosis.<\/p>\n It is always necessary for a friend or relative to drive\u00a0you home if you have had an EUS as an out-patient\u00a0because it takes several hours for the effects of the\u00a0drugs to wear off.<\/p>\n This is a special scan performed in the Nuclear\u00a0Medicine Department and is sometimes performed in\u00a0certain centers if there is uncertainty as to the\u00a0diagnosis. (Cancer versus inflammation).<\/p>\n Patients are fasted for 6 hours before going to the\u00a0Nuclear Medicine Department. You are asked to lie\u00a0down on a special couch underneath a special camera\u00a0called a gamma camera. Fifteen minutes or so after\u00a0the intravenous injection of a special chemical the\u00a0camera will take images of your pancreas. The\u00a0chemical contains a small amount of relatively\u00a0harmless radioactivity. Your doctors will explain the\u00a0results to you once they have put together the In the newer generation machines CT & PET\u00a0technology has been combined to give more specific\u00a0information. Hence now clinicians ask for this\u00a0whenever required.<\/p>\n This is a test to look at blood vessels. Diseases of\u00a0liver, biliary tract & pancreas can involve the large\u00a0blood vessels that carry blood to and from the liver.\u00a0An angiogram may be used to check whether any of\u00a0these blood vessels are affected by the cancer or\u00a0sometimes in case of postoperative biliary injury.<\/p>\n Conventionally angiograms are carried out in the xray\u00a0department. A fine tube is put into a blood vessel\u00a0(artery) in your groin. A dye is then injected up the\u00a0tube. The dye circulates in the arteries so that they\u00a0show up on x-ray. Now the role for this conventional\u00a0angiogram is reduced since very good angiograms are\u00a0obtained during CT scan or MRI study and\u00a0information regarding various arteries and veins can\u00a0be achieved in minutes with much less discomfort.<\/p>\n Conventional Angiography is used now mainly for\u00a0therapeutic purposes like control of bleeding vessels,\u00a0inserting a stent in the blocked artery, portal vein or\u00a0vena cava. Sometimes stent is inserted to relieve the\u00a0blocked hepatic veins.<\/p>\n A biopsy is obtaining a small piece of tissue from the\u00a0organ concerned or mostly from a tumor for\u00a0diagnosis. Occasionally a small piece of tissue from\u00a0the pancreas or liver needs to be taken to help make a\u00a0diagnosis. There are many ways that this can be done\u00a0especially using an ultrasound scan or a CT scan to\u00a0tell the doctor where to pass the needle. This\u00a0procedure requires informed, written consent.<\/p>\n Biopsy or cytology is done taking sterile precaution.\u00a0The skin is cleaned with an antiseptic. Local\u00a0anesthetic is injected into the skin. A very fine needle\u00a0is then introduced and its tip positioned using pictures\u00a0from the scan before any tissue is taken.<\/p>\n If solid tissue is taken, however small this is called a\u00a0biopsy and is examined by a pathologist using a\u00a0microscope (called histology<\/strong>). Because a needle is\u00a0used it is called a needle biopsy<\/strong>. If only some\u00a0individual cells have been removed and examined by\u00a0a special pathologist called the examination is called\u00a0cytology<\/strong>. Because the cells are obtained by a sucking\u00a0action (or aspiration) on the needle using a syringe,\u00a0the procedure is called aspiration cytology<\/strong>.<\/p>\n These procedures are surprisingly safe in specialist\u00a0centers. But complications such as bleeding can occur\u00a0occasionally.<\/p>\n The results of biopsy or cytology are often not easy to\u00a0interpret and may take a while for them to become This is a small operation that allows the doctors to\u00a0look at the gall bladder, the liver and other internal\u00a0organs in the area around the gall bladder. This is\u00a0usually done prior to the major surgery to confirm that\u00a0patient will benefit by a major surgery. It is done\u00a0under local or general anesthesia and will mean a\u00a0short stay in hospital.<\/p>\n While you are under anesthesia the doctor makes a\u00a0small cut (incision) in your abdomen and inserts a thin\u00a0rigid tube containing a light and camera\u00a0(laparoscope). The doctor looks at the internal organ\u00a0and may take a small sample of tissue (biopsy) for\u00a0examination under a microscope or collect fluid\u00a0present within the abdominal cavity and send it for\u00a0various tests in order to pick up the diseases like\u00a0cirrhosis, tuberculosis or cancer.<\/p>\n After the laparoscopy you will have one or two\u00a0stitches in your abdomen. You may have\u00a0uncomfortable wind and\/or shoulder pains for couple\u00a0of days after the operation.<\/p>\n Laparoscopy is not without complications & requires\u00a0informed consent. In experienced hands less than 1 % <\/p>\n Note:<\/strong> Above information will help you to make an\u00a0informed decision but it cannot replace the\u00a0professional advice and expertise of a doctor\u00a0who is familiar with your condition. You may\u00a0have questions that are not covered; you\u00a0should discuss these with your surgeon. You\u00a0must remember every individual is different.<\/p>\n","protected":false},"excerpt":{"rendered":" When a patient is suspected or diagnosed with a\u00a0liver, gall bladder or pancreatic problem, a whole\u00a0list of investigations are asked quite often,\u00a0confusing the patient and the family regarding the\u00a0reason behind so many expensive investigations, especially when it becomes difficult to give a\u00a0certain answer after they are done or they are…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"yst_prominent_words":[],"class_list":["post-25","post","type-post","status-publish","format-standard","hentry","category-common-investiagations","loop-entry clr boxed"],"_links":{"self":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/25","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/comments?post=25"}],"version-history":[{"count":1,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/25\/revisions"}],"predecessor-version":[{"id":26,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/25\/revisions\/26"}],"wp:attachment":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/media?parent=25"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/categories?post=25"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/tags?post=25"},{"taxonomy":"yst_prominent_words","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/yst_prominent_words?post=25"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}ENDOSCOPIC RETROGRADE
\nCHOLANGIOPANCREATOGRAPHY (ERCP)<\/h2>\n
\neasier to insert bigger instruments into the bile duct or\u00a0pancreatic duct to remove any gallstones or pancreatic
\nstones.<\/p>\nIs ERCP safe?<\/h2>\n
For these reasons, an ERCP must be:<\/strong><\/h4>\n
\n
PERCUTANEOUS TRANS HEPATIC\u00a0CHOLANGIOGRAPHY (PTHC)\u00a0&\u00a0PERCUTANEOUS TRANS HEPATIC BILIARY
\nDRAINAGE (PTBD)<\/h2>\nIs PTHC safe?<\/h2>\n
\nintravenous fluid, antibiotics and a urinary catheter.<\/p>\nENDOLUMINAL ULTRASOUND (EUS)<\/h2>\n
\ngallbladder and the liver.<\/p>\nPOSITRON EMISSION TOMOGRAPHY (PET\u00a0SCAN)<\/h2>\n
\ninformation from the PET scan as well as other tests\u00a0such as results from the CT scan.<\/p>\nPET CT<\/h2>\n
ANGIOGRAM<\/h2>\n
NEEDLE BIOPSY OR CYTOLOGY USING\u00a0ULTRASOUND OR CT SCAN<\/h2>\n
Are needle biopsy and aspiration cytology safe?<\/h2>\n
\navailable. The results are usually combined with other\u00a0tests to provide an overall diagnosis.<\/p>\nLAPAROSCOPY<\/h2>\n
\npatients have complications & they include bleeding,\u00a0bowel perforation & infection. Risk of death is less\u00a0than 1 %.<\/p>\n