Biliary Flashcards
chole
bile
cysto
bag or sack
cholecyst
gallbladder
choledocho
common bile duct
cholangio
bile vessel
gall bladder location in hypersthenic
2” higher (T12) and lateral
gallbladder location in sthenic patient
L2 or 1” above LCM and 2” to the right of MSP
gallbladder location of Asthenic patient?
midline at L4
functions of the gallbladder
- storage of bile
- concentration of bile
- contraction when stimulated (cholecystokinin - CCK)
cholecystography
study of gall bladder
cholangiography
study of biliary ducts
cholecystangiography
study of GB and ducts
examinations of the gall bladder
- percutaneous transhepatic cholangiography
- T-Tube cholangiogram
- endoscopic retrograde cholangiopancreatogram - ERCP
patency of ducts would require what kind of examine
stenosis
GB tumours requires what type of exam?
biliary neoplasia
Gallstones requires which type of exam?
cholelithiasis
cholelithiasis
cholesterol is radiolucent
- majority of gall stones are radiolucent
- see filling defect with contrast
- 20% contain enough calcium to be seen radiographically
- ultrasound is modality of choice for diagnosis
PTC - percutaneous transhepatic cholangiography
in the OR
Diagnostic or therapeutic
- Insertion of needle through the skin into a bile duct
- Injection of dilute contrast
- May drain excessive fluid
- May remove stones or sludge causing obstruction
- May insert stents
- Often for palliative patients
slide 11
PTC images
T-Tube Cholangiogram
- Biliary tract examination that is performed via a T-shaped or pigtail-shaped catheter left in the common hepatic and common bile ducts for postoperative drainage (often after removal of the gallbladder)
- To show the caliber and patency of the ducts, or the presence of residual or previously undetected stones
prep for T-tube cholangiogram?
- The drainage tube is clamped the day before
- The preceding meal is withheld
- May need cleansing enema 1 hour before
why is a pigtail catheter required
- pigtail catheter is required for laparoscopic biliary procedures because it can be placed percutaneously. The T-tube catheter can be placed only during an open surgical procedure.
density of contrast
- The density of the contrast medium used no greater than 25% to 30% because small stones may be obscured with a higher concentration
slide 13
what position is this?
slide 15
lateral projection
what is lateral projection used to show?
anatomic branching of the hepatic ducts in the plane and to detect any abnormality that is not otherwise shown
ERCP - endoscopic retrograde cholangiopancreatogram
- Endoscopic inspection, cannulation, and injection of the biliary ducts with the use of a duodenoscope (fiberoptic endoscope) by a Gastroenterologist
- In the Endoscopy suite or Radiology Suite
- Mostly CT used now
what is ERCP used to treat?
ERCP remains a mainstay on the treatment of choledocholithiasis and malignant obstructive jaundice
responsibilities of technologist
- Prepare fluoroscopy suite
- Set up examination tray
- Select and prepare contrast media, - medications are prepared by RN - patient will receive anesthetic at back of throat
- Take scout images
- Provide protective aprons
- Monitor the patient during the procedure
- Take conventional radiographs or fluoro images as requested
alternate imaging of gall bladder
ultrasound - most common
CT - secondary study
MRI - not as common
choledocholithiasis
stones of the common bile duct
cholecystitis
gall bladder inflammation
slide 21 and 22
know procedure and anatomy
