Diagnosis

♦ Blood tests—obstructive jaundice —if cholangitis (transminases x 5)

—tumour markers CA19—9, ACE elevated —coagulation abnormality (Vitamin K deficiency)

♦ Ultrasound—level of obstruction —excludes stones

—may see nodes or hepatic secondaries —doppler to assess vessels

—endoscopic ultrasound good for tumour of lower one third

♦ CT scan—excludes cancer of head of pancreas

—assesses liver

♦ Angiography—useful 'road map' for surgeon

♦ MRI cholangiography—good biliary tree map

♦ Percutaneous cholangiography

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