Preoperative evaluation of the biliary tract.

When clinically suspected, obstructive jaundice presents the clinician with the problem of selecting the most suitable tests and determining the order in which they should be performed. Technology has provided a number of highly specific and quite expensive procedures. The studies most appropriately performed are ultrasonography, percutaneous transhepatic cholangiography, ERCP, flexible choledochoscopy, CT scan of the abdomen, HIDA scan, and intravenous cholangiography. The algorithmic approach is clinically helpful in this situation and is recommended as a useful guide.