ERCP,MRCP,HIDA Scan

• Biliary radionuclide scanning (HIDA scan) may be of help in the atypical case. Lack of filling of the gallbladder after 4 hours indicates an obstructed cystic duct and, in the clinical setting of acute cholecystitis, is highly sensitive and specific for acute cholecystitis. A normal HIDA scan excludes acute cholecystitis.
• Best screening method for Mirizzi syndrome is: ERCP.
• Risk factors for post-ERCP pancreatitis are minor papilla sphincterotomy, sphincter of Oddi dysfunction, prior history of post-ERCP pancreatitis, age 2 contrast injections into the pancreatic duct..
• Elective ERCP with sphincterotomy is considered in patients with persistent / incipient biliary obstruction, those who are  poor candidates for cholecystectomy, and for those in whom there is strong suspicion for bile duct stones after cholecystectomy. ERCP with stent placement is indicated for pancreatic ductal disruptions..
• Urgent ERCP  is indicated in patients who have severe acute biliary pancreatitis with cholangitis.
• ERCP in pancreatitis is done to know about Gall Stones.
• Magnetic resonance cholangio pancreatography (MRCP) is a non – invasive alternative to evaluate biliary tree.It is used to obtain the image.
• Best investigation for acute cholecystitis is HIDA Scan.
• ERCP is the gold standard for diagnosing CBD stones..
• ERCP, sphincterotomy and balloon clearance is now the standard treatment for stone in the common bile duct.
• ERCP may provide direct diagnosis of the distal CBD pathology and may be therapeutic as well for a CBD stone or stricture..
• 5 days after CBD surgery there is a small leak. ERCP and Stenting will be the best T/t.
• ERCP is the most sensitive test for detecting pancreatic cancer but CT scan is the inv. of choice.
• Most common complication after ERCP is Acute pancreatitis.
• Best investigation for diagnosis of ampullary gall stone with obstructive jaundice is ERCP.
• Chain of lakes appearance on ERCP is seen in Chronic Relapsing Pancreatitis.
• On HIDA scan. gall bladder is not visualized.
• Magnetic resonance cholangiopancreatography (MRCP) is not a cause of Acute pancreatitis.
• Principle of MRCP:Use of heavily T2-weighted image without contrast to create the three dimensional image of the biliary tree using MIP algorithm.
• A 3-month-old child with history of passage of clay colored stools and dark yellow urine since one month was given steroids and ursodeoxycholic acid. On further investigation, he was found to have direct bilirubin of 6 mg%. HIDA Scan is the most sensitive investigation for the diagnosis of above-mentioned condition.

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