Advanced Digestive Flashcards
Biliary System
invloves
- liver
- gall bladder
- right and left Hepatic ducts
- common hepatic duct
- cystic duct
- common bile duct
- pancreatic duct + Sphincter of Oddi
Liver
Largest solid organ
3-4lbs
triangular; highly vascular
gallbladder located in the posterior inferior region
4 lobes : (1) right (largest), (2) left- separated by falciform ligament , (3) quadrate and (4) caudate
produces bile
Gall Bladder
- pear shaped; 7-10cm long and 3cm wide
- 3 parts: (1) fundus- distal end; broadest part (2) body- main section (3) neck- narrow, proximal end
- stores 30-40mL of bile
- Primary functions: (1) stores bile, (2) concentrate bile (hydrolysis) and (3) contrast when stimulated (by CCK)
pathway of bile from the liver
- bile travels from the liver through the left and right hepatic ducts
- the left and right hepatic ducts then join and continue as the common hepatic duct
- bile then travels to the gallbladder via the cystic duct to be temporarily stored
- bile is secreted into the duodenum via the common bile duct
- common bile duct is joined by the pancreatic duct at the hepatopancreatic sphincter (Sphincter of Oddi)
- the common bile duct + pancreatic duct empty into the duodenum via the duodenal papilla
Common Bile Duct
- 7.5cm long
- descends behind the superior portion of the duodenum + head of the pancreas to enter the descending portion of the duodenum
- in 60% of patients the common bile duct and the pancreatic duct join to form a common passage (in 40% they pass seperately)
Choledocholithiasis
the presence of stones in the biliary ducts. these stones may often produce a blockage in the ducts. Symptoms include pain, tenderness in RUQ, jaundice, and sometimes pancreatitis
Cholelithiasis
COndition of having abnormal caclifications or stones in the gallbladder. Two types:
(1) cholesterol- 75%
(2) Pigment
Risk factors: family history, excessive weight , being over 40, female
Symptoms: RUQ pain, nausea, possible vomitting
Cholecystitis
inflammation of the gallbladder
Acute: often a blockage of the cystic duct restricts the flow of bile from the gall bladder to the CBD (95% of blockages are due to stones)
Chronic: almost always assisocatied with gallstones but may also be the otucome of pancreatitis or carcinoma of the gall bladder
Neoplasms
new growths which may be benigin or malignant
- of the malignant tumors 85% are adrenocarcinomas and 15% are squamous cell carcinomas
- Common benign tumors are arenomas and cholesterol polyps
- 80% of patients with carcinoma of the gallbladder have stones
Biliary stenosis
narrowing of one of the biliary ducts. the flow of bile may be restricted by this condition. May prevent the passage of stones.
Oral Cholecystogram: Indications
nasuea, heartburn, vomitting
Oral Cholecystogram: procedure
- no longer preformed
- 6 tablets injested at various times to introduce contrast into the gallbladder
- replased by ultrasound because:
(1) less prep, (2) better visualization (3) no radiation and (4) faster
Oral Cholecystogram: postioning
Images taken in an LAO 35-40 degrees
Endoscopic Retrograde Cholangiopancreatography (ERCP) : Incications / Contraindications
indications: Calculi, strictures,
Contraindications: contrst allergy, acute infection, pancreatic pyeudocyst
ERCP: prep and equipment
Patient prep: review clinical history, NPO at least 8 hours, anesthetic
Equipment: fluroscopy, contrast, syringes, sterile drapes, scope, catheter, adaptors, endoscope monitor, emesis basins
ERCP: contrast + process
Contrast: water soluble, iodinated contrast; retrograde
Process: sterile procedure. endoscope inserted through the mouth into the duodenum until the hepatopanceratic ampulla (ampulla of vater). Catheter is inserted into the CBD. flruoscopy is used to evaluate the CBD and surronding structures
Can sometimes be theraputic after the issue is discovered. i.e. spnicterotomy to allow the passage of large stones
What procedure allows for the selection of the pancreatic duct?
ERCP
Operative Cholangiogram : indications/ contraindications
Indications: residual calculi, strictures
Contraindications: contrast allergy elevated creatinine and or BUN
OR Cholangiogram: patient Prep and equipment
patient prep: general anesthetic, NPO
Equipment: mobile + cassette or C-arm
OR Cholangiogram: Contrast, positonings and process
Contrast: iodinated, water soluble; retrograde
Postions:
supine
and/or RPO
Process: surgeon injects contrat into the biliary tree.
possible- laproscopic cholesystotomy or t-tube insertion
T-Tube Choleangiogram
- AKA postoperative choleangiogram or delayed cholangiogram
- sterile procedure
T-Tube Cholangiogram : Indications/ contraindications
Indications: residual calculi, strictures
Contraindications: contrast allergy elevated creatinine and or BUN
T-Tube Cholangiogram: Patient Prep and equipment
patient prep: clamping the t-tube will help reduce the air in the biliary tract (reduces the likihood of misidagnosis of stones), NPO 8 hrs
Equipment: fluroscopy, syringes, adaptors, sterile tray
T-tube Cholangiogram : contrast, process and positoning
Contrast: iodinated, water soluble ;retrograde
Process: rad injects contrast into the biliary tact via T-Tube
position:
supine
and/or RPO
