[Diagnostic strategy of the liver and bile ducts]

The diagnosis of gallbladder and liver diseases depends primarily on noninvasive techniques (ultrasound and computer tomogram). Gallstones can be detected by ultrasonography in more than 90% of such patients and this is a sufficient indication for operation. The preoperative diagnosis of stones of the biliary tract by sonography is however, unreliable. Even a preoperative endoscopic retrograde cholangio-pancreaticography cannot justify foregoing an intraoperative cholangiogram. Detection of metastasis is still a problem in the diagnosis of liver tumors. Further developments in computed tomogram and scintigram techniques, however, promise improvements.