IMAGING

Ultrasound

Appropriate when pattern of liver tests suggests cholestatic disorder

Distinguish intrahepatic from extrahepatic disorders

Inexpensive

No ionizing radiation

Can detect dilatation of intra- and extrahepatic biliary tree with high degree of sensitivity
and specificity

Absence of biliary dilatation suggests intrahepatic cholestasis

Presence of biliary dilatation indicates extrahepatic cholestasis

Rarely identifies site or cause of obstruction

Distal common bile duct particularly difficult to visualize because of overlying bowel gas

False negative occurs in patients with

Partial obstruction of the common bile duct

Cirrhosis or primary sclerosing cholangitis (PSC), where scarring prevents intrahepatic

ducts from dilating

If you look at the imaging, there shouldn’t have space between the liver and the right
kidney

Most common: portal hypertension

Indentifying choledocholithiasis in distal common bile duct

When ducts are not dilated