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RADT2000 > Advanced Digestive > Flashcards

Advanced Digestive Flashcards

1
Q

Biliary System

A

invloves

  1. liver
  2. gall bladder
  3. right and left Hepatic ducts
  4. common hepatic duct
  5. cystic duct
  6. common bile duct
  7. pancreatic duct + Sphincter of Oddi
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2
Q

Liver

A

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

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3
Q

Gall Bladder

A
  • 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)
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4
Q

pathway of bile from the liver

A
  • 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
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5
Q

Common Bile Duct

A
  • 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)
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6
Q

Choledocholithiasis

A

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

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7
Q

Cholelithiasis

A

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

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8
Q

Cholecystitis

A

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

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9
Q

Neoplasms

A

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
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10
Q

Biliary stenosis

A

narrowing of one of the biliary ducts. the flow of bile may be restricted by this condition. May prevent the passage of stones.

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11
Q

Oral Cholecystogram: Indications

A

nasuea, heartburn, vomitting

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12
Q

Oral Cholecystogram: procedure

A
  • 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
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13
Q

Oral Cholecystogram: postioning

A

Images taken in an LAO 35-40 degrees

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14
Q

Endoscopic Retrograde Cholangiopancreatography (ERCP) : Incications / Contraindications

A

indications: Calculi, strictures,
Contraindications: contrst allergy, acute infection, pancreatic pyeudocyst

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15
Q

ERCP: prep and equipment

A

Patient prep: review clinical history, NPO at least 8 hours, anesthetic
Equipment: fluroscopy, contrast, syringes, sterile drapes, scope, catheter, adaptors, endoscope monitor, emesis basins

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16
Q

ERCP: contrast + process

A

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

17
Q

What procedure allows for the selection of the pancreatic duct?

A

ERCP

18
Q

Operative Cholangiogram : indications/ contraindications

A

Indications: residual calculi, strictures
Contraindications: contrast allergy elevated creatinine and or BUN

19
Q

OR Cholangiogram: patient Prep and equipment

A

patient prep: general anesthetic, NPO

Equipment: mobile + cassette or C-arm

20
Q

OR Cholangiogram: Contrast, positonings and process

A

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

21
Q

T-Tube Choleangiogram

A
  • AKA postoperative choleangiogram or delayed cholangiogram

- sterile procedure

22
Q

T-Tube Cholangiogram : Indications/ contraindications

A

Indications: residual calculi, strictures
Contraindications: contrast allergy elevated creatinine and or BUN

23
Q

T-Tube Cholangiogram: Patient Prep and equipment

A

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

24
Q

T-tube Cholangiogram : contrast, process and positoning

A

Contrast: iodinated, water soluble ;retrograde
Process: rad injects contrast into the biliary tact via T-Tube
position:
supine
and/or RPO

25
Q

percutaneous transhepatic cholangiogram (PTC): Indications/ Contraindications

A

Indications: residual calculi, strictures, Failed ERCP, neoplasms, liver diease
Contraindications: contrast allergy elevated creatinine and or BUN

26
Q

PTC risks

A

hemmorage, infection, pneumothorax

27
Q

PTC patient prep and eqipment

A

Patient prep: done under conscious sedation, local, can be theraputic as well as diagnostic
Equipment: chiba needle, US, Fluroscopy
Done in IR

28
Q

PTC: Contrast + procedure

A

Contrast: iodonated, water soluble
Procedure: pt. suspends breathing and the RAD accesses the liver using the chibba needle in the 10th intercostal space on the right. Any drians placed require 6 months to heal post PTC

29
Q

PTC: types of drains

A

external: pigtail; drains bile outside of the body

Internal/external: can drain into the duodenum and outside the body

30
Q

Salivary Glands + Ducts

A

salivary glands:

  • parotid
  • submandibular/ submaxillary
  • sublingual

Salivary Ducts

  • Stensens (parotid)
  • Whartons (submandibular)
  • Bartholins (12 ducts of Rivinus)
31
Q

Sialography: Indications/Contraindications

A

indications: stones (sialolithisis), obstruction/ fissures, pain/swelling, infection, masses, tumors

Contraindications: history of contrast allergy, parotitis (mumps), severeve inflammation of the salivary glands

32
Q

sialography: Equipment, contrast, positioning and procedure

A

Equipment: lemon juice, gauze, gloves, serile towels, spotlight, mask, sialogram tray

Contrast: Oil based or iodinated water soluble

Positioning :
parotid- AP and possible obliques
submandibular- Lateral

procedure
contrast injected into salivary duct to enter gland

33
Q

enteroclysis: indications / contraindications + advantages and disadvanteges

A

indications: suspected/known small bowel obstruction, neoplasms, inflammatory bowel diease, malabsorpsion, polyps, adhesive bands
contraindications: perforation, post-op,
disadvantages: tube placement, dose
advanteges: time, visualization

34
Q

enteroclysis: contrast and procedure

A

contrast- barium and air or methylcellulose (iodinated of going to CT); antegrade

Procedure: using a guidewire, a catheter is placed into the duodenojejunal junction at the ligament of treitz. Then contrast is injected (1st positive then negative). DOuble contrast dilates the bowel loops + enhances mucosa

35
Q

Defecogram

A
  • a functional study of the rectum and anus
  • indications: intussusception, rectocele, rectal prolapse, fecal incontinence, difficulty defecating
  • contrast: high-density barium sulphate; retrograde
  • equipment: commode, waste bag, platform, syringe
  • contraindications: post-op

all images must include the analrectal angle

36
Q

sinuses + fistulas

A

sinuses: tract that leads to an absess

Fistula: abnormal passage between structures

37
Q

sinograms and fistulagrams

A
  • may or may not be sterile
  • done under fluro
  • barium or water-soluble, iodinated contrast
  • external opening or internal tract: may be large therefore have many different sized catheters on hand

RADT2000 (7 decks)

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