Value of ultrasound and liver function tests in determining the need for endoscopic retrograde cholangiopancreatography in unexplained abdominal pain.
نویسندگان
چکیده
The value of serum liver function tests and abdominal ultrasound as screening tests of the need for endoscopic retrograde cholangiopancreatography (ERCP) was determined in patients with unexplained abdominal pain without associated jaundice. In 1989 and 1990 1005 ERCPs were undertaken, of which 138 (14%) were for this indication. The duct or ducts of interest were delineated by ERCP in 95% of patients. The lesions found were bile duct stones in 10 patients, chronic pancreatitis in five, pancreatic carcinoma in one, peptic ulcer or duodenitis in four. A satisfactory ultrasound examination had been performed in 94% of patients. For chronic pancreatitis, its sensitivity was 60% and specificity 95%. For choledocholithiasis, the ultrasonic detection of duct dilatation or stones had a sensitivity of 90% and specificity of 86%. Of the liver function tests, the alkaline phosphatase was more sensitive (67%) than the transaminases (44%) in indicating the presence of bile duct stones and had a high specificity (95%). None of the 10 patients with duct stones had normal ultrasound and normal alkaline phosphatase. Thus it was found that demonstration of a normal common bile duct by abdominal ultrasound and normal serum alkaline phosphatase together have 100% specificity in excluding bile duct stones. Using such knowledge over the two year period of this study would have spared 36 patients the need for ERCP.
منابع مشابه
Abdominal pain and abnormal liver tests after orthotopic liver transplantation.
A 53-year-old man is seen in clinic 4 months after receiving an orthotopic liver transplant (OLT) for two small (<3 cm in diameter) hepatomas which were discovered incidentally. The patient had a history of heavy alcohol use in his twenties and thirties, but has not used alcohol for over 10 years. Liver histology on the resected organ revealed early micronodular cirrhosis with the two tumor nod...
متن کاملAngiosarcoma of the Liver
On examination, the epigastrium was tender but no mass was palpable. Investigations for his epigastric pain showed normal levels of serum amylase, normal electrocardiograph, normal erect abdominal and chest Xray. Further tests done included abdominal ultrasound that showed hyperechoic lesion in the gallbladder, suggestive of a polyp. The liver, spleen and pancreas were reported as normal. OGDS ...
متن کاملEndoscopic ultrasound-guided gallbladder drainage to facilitate biliary rendezvous for the management of cholangitis due to choledocholithiasis.
An 81-year-old man presented with upper abdominal pain, nausea, and vomiting, with elevated liver test results. Abdominal computed tomography demonstrated mild intraand extrahepatic biliary ductal dilation (common bile duct 11mm), with choledocholithiasis, layering gallstones, and enhancement and thickening of the gallbladder wall. Endoscopic retrograde cholangiopancreatography (ERCP) was attem...
متن کاملTension pneumothorax and widespread pneumatosis after endoscopic retrograde cholangiopancreatography.
699 September 2013 A previously healthy, 23-yr-old woman presented to the emergency department with a 1-day history of severe upper abdominal pain, nausea, and teacolored urine. on physical examination, jaundice and scleral icterus were noted with increased liver function tests and an abdominal ultrasound that demonstrated gallstones. she underwent an endoscopic retrograde cholangiopancreatogra...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Gut
دوره 33 11 شماره
صفحات -
تاریخ انتشار 1992