Choledocholithiasis — ESEGH MCQ

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HardPancreatico-biliary DiseaseCholedocholithiasisESEGH

Ultrasound shows no common-bile-duct stone, but the duct is dilated and alkaline phosphatase and bilirubin are raised. There is no cholangitis. What is the next diagnostic test?

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Correct answer: D — Magnetic resonance cholangiopancreatography

The best answer is “Magnetic resonance cholangiopancreatography”. NICE recommends MRCP after negative ultrasound when duct dilatation or abnormal liver tests maintain suspicion; EUS follows if MRCP is nondiagnostic. “Diagnostic ERCP as the first test” is less appropriate because ERCP carries pancreatitis risk and is reserved when therapeutic intervention is likely “Repeat liver tests in 2 years” is less appropriate because this delays evaluation of probable obstruction “Routine diagnostic colonoscopy at this stage” is less appropriate because this does not image the bile duct “Hepatitis B viral load alone” is less appropriate because viral replication does not explain the duct dilatation

Reference: NICE CG188 gallstone disease: https://www.nice.org.uk/guidance/cg188/chapter/3-other-information