Alternative PPT

Question 1

Cholegraphy

Answer 1

Radiographic study of the

Biliary system

Question 2

Cholecystography

Answer 2

Radiographic investigation

of the Gallbladder

Question 3

Choliangography

Answer 3

Biliary ducts

Question 4

***What does PTC stand for?

Answer 4

Percutaneous Transhepatic Cholangiography

Question 5

PTC Procedure:

Answer 5

Right side of patient is prepped with local anesthetic
Chiba needle is inserted through right lateral intercostal space and advanced to liver hilum
Stylet is removed and syringe with contrast is attached to needle
After filling of ducts needle is withdrawn

Question 6

If dilated biliary ducts are identified

Answer 6

A drainage catheter is placed into biliary duct

Question 7

Guidewire is passed through

Answer 7

Needle lumen & needle is removed

Question 8

Catheter is passed over

Answer 8

Guidewire and wire is removed

Left in place for prolonged drainage

Question 9

***PTC Procedure is used for

Answer 9

• Preoperative radiologic examination
• Jaundice patients with positive CT or sonogram
for dilated ductal system
– Cause is unclear
• Utilizes a _CHIBA_____ or “skinny” needle
• Procedure also is used to place drainage
catheter for treatment of obstructive jaundice

Question 10

Postoperative (T-Tube) Cholangiography also known as

Answer 10

Postoperative,

Delayed or T-tube choliangiography

Question 11

***Explain the postoperative t-tube cholangiograpm:

Answer 11

Exams the biliary tract using a T-shaped or pigtail shaped catheter
Follows a cholecystectomy
Left in common hepatic & common bile ducts for postoperative drainage

Question 12

What type of procedure is used to place a T-tube and pigtail catheter?

Answer 12

T-tube is placed during a surgical procedure

Pigtail catheter is placed during a laparoscopic biliary procedure

Question 13

***What is the purpose of the postoperative T-tube cholangiogram?

Answer 13

Demonstrates caliber & patency
Status of sphincter of hepatopancreatic ampulla
Presence of stones or other pathologic conditions such as strictures

Question 14

Why is the drainage tube clamped the day before the procedure?

Answer 14

Allows tube to fill with bile to prevent air bubbles within the duct from mimicking stones (preventive measure)

Question 15

Water-soluble iodinate contrast

– Density of no more than

Answer 15

5% to 30%

• Obscured small stones

Question 16

How to position pt for Postoperative Cholangiogram Procedure

Answer 16

Place patient in an _RPO______
– RUQ is centered to midline of grid
– Projects biliary ducts away from spine

Question 17

Images are taken during fractional injections and

specified intervals until contrast has entered

Answer 17

Duodenum

Question 18

Lateral projection of Postoperative Cholangiogram to demonstrate

Answer 18

Anatomic branching of hepatic ducts & to detect any abnormality

Question 19

***Clamp is generally not removed from

Answer 19

Tube before procedure is complete

– Drainage of excess bile @ beginning of study

Question 20

***ERCP Stand for

Answer 20

Endoscopic Retrograde Cholangiopancreatography

Question 21

***What is the purpose for an ERCP?

Answer 21

It is used to diagnose biliary and pancreatic pathology

Therapeutic procedure: Removal of choleliths or small lesions & Repair a stenosis of a duct

Question 22

ERCP Procedure:

Answer 22

Endoscope is placed through mouth into duodenum
A small cannula is passed into the hepatopancreatic ampulla
Contrast is then injected into common bile duct (retrograde injection)
Contrast drains from ducts within 5 minutes of injection

Question 23

ERCP is useful when biliary ducts are NOT

Answer 23

Dilated and no obstruction exist @ ampulla