Investigation of choice in choiedochoiithiasis -

Ans. is 'c' i.e., USG Gail stoneo The most common disease of gall bladder is caused by gall stones formed by the precipitation of the constituents of bile . A gallstone gives rise to symptoms. Movements may result in its obstructing the cystic duct with resultant acute cholecystitis, or the stone may migrate into the common bile duct causing obstruction to the main outflow of bile from the liver.o Investigations of gall bladder disease are >Ultrasonography : - This is the investigation of choice for the detection of gallstones, and obstructive jaundice. USG shows echogenic focus with posterior acoustic shadowing. The most specific sign of a contracted, stone filled gallbladder is a hypoechoic wall superficial to a curvilinear echo from the stones and an acoustic shadowWES triad (Wall, Echo, Shadow) or the "Double arc shadow sign".Plane x-rayOnly 10% of gall stones are radio-opaque. Therefore, plane x-ray is of limited value.Oral cholecystogram (OCG) Dye used for OCG is ipanoic acid. Filling defect, due to stones, will be seen within the gall bladder. Cholangiogrant (outline of common bile duct) intravenous injection of biligrafin is given and frequent radiograph are taken as the liver excretes the biligrafin. Impacted stone in CBD classically shows cresentic shadow or meniscus sign on cholangiogram.Percutaneous transhepatic cholangiography (PTC) : - This is a useful procedure in obstructive lesions. It is usually done as an immediate preoperative investigation. PTC can be used for drainage, cholangioplasty and stent placement.