Parasites and Biliary stones

Choledocholithiasis ٧٥
transpeptidase (GGT) and alkaline phosphatase (ALP) were the most
frequent biochemical abnormalities in patients with symptomatic
choledocholithiasis (Anciaux et al., 1986). Serum bilirubin levels may be
markedly elevated depending on whether the obstruction of the bile duct
is complete or incomplete. (Sarli et al., 2000). Most of the studies have
emphasised that laboratory investigations must be used in addition to
other imaging modalities to predict the likelihood of common bile duct
stones (Tham et al., 1998).
Imaging Studies:
Several diagnostic modalities are available, and these are best
divided into preoperative, intraoperative, and postoperative studies. The
latter are used for the diagnosis of retained common bile duct stones
(Dandan et al., 2005).
Preoperative studies:
Plain abdominal radiography: A plain film of the upper abdomen may
show radio-opaque calculi. It is uncommon to demonstrate a stone, in the
duct by this technique, failure to demonstrate the presence of gallstones is
no way invalidates the diagnosis since 10-15% only of gallstones are
radio-opaque (Cuschieri, 2002).
Transabdominal Ultrasonography (TUS): It remains the first line
radiological investigation in patients with suspected CBDS. It has a high
sensitivity of detecting both intrahepatic and extrahepatic biliary
dilatation. The sensitivity of TUS compared to endoscopic retrograde
cholangiopancreatography (ERCP) in detecting common bile duct
dilatation was 96% (Stott et al., 1991). However, the sensitivity of TUS
in detecting choledocholithiasis is much lower with sensitivities of
between 25% and 63% when compared to endoscopic ultrasound (EUS)