Page 141 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
24 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Jaundice and Liver Disease
Ultrasound should usually be the first line investigation for differentiating between medical and surgical causes of jaundice or in the investigation of the cause of abnormal liver function.
In patients with suspected malignancy abdominal CT is usually preferred over ultrasound unless the patient has renal impairment or a contraindication to contrast or suspected biliary obstruction.
MRCP may be indicated if ultrasound and CT do not identify a cause of an obstructed system. MRI may be needed in screening for hepatoma if too obese for US imaging
The new National Community Radiology Access Criteria have the following indications for referral for abdominal ultrasound in suspected liver disease and other abdominal conditions:
• abdominal mass or other palpable abdominal abnormality
• painless jaundice without obvious cause
• suspected gallstones: persistent/recurrent right upper quadrant pain
• suspected pancreatic disease (limited resolution in obesity and CT may be more appropriate)
• abnormal LFTS; both GGT and ALT >1.5 times ULN for >3 months with no other cause
• abnormal LFTS suggestive of biliary tract obstruction or malignancy (persistently raised ALP/GGT+/- bilirubin).
The Criteria note that referral for ultrasound is not typically indicated in:
• infective hepatitis
• acute abdomen or suspected bowel obstruction
• dyspepsia
• suspected colorectal neoplasm
• clinically evident hernia in adults
• screening for AAA
• Clinical urgency: Dependent on acuity. Imaging will not usually be performed after 2200
The ‘Choosing Wisely’ recommendations include:
Don’t perform CT or MRI routinely to monitor benign focal lesions in the liver unless there is a major change in clinical findings or symptoms