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Rad 112 > Biliary And Urinary > Flashcards

Biliary And Urinary Flashcards

0
Q

List 3 primary functions of the GB

A

Stores bile
Concentrates bile
Contracts to release bile when stimulated by CCK

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1
Q

Name the shape and the 3 parts of the GB

A

Pear shaped

Neck body and fundus

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2
Q

List the passage of bile from the small lobes of the liver to the release into the duodenum

A

L&R hepatic duct➡️common hepatic duct ➡️cyclic duct➡️GB➡️cystic duct➡️️common bile duct➡️junction of the main pancreatic duct➡️ampulla of vater➡️sphincter of oddi➡️terminal opening➡️duodenum

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3
Q

List all exams with the biliary system that spot fluoro or digital radiographs are the only basic images taken

A

PTC
ERCP
T TUBE or Post op or Delayed Cholangiogram
Surgery exams

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4
Q

Which biliary system exam may warrant a chest x ray immediately following the procedure an why

A

PTC

Needle may hit lung (pneumothorax)

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5
Q

List basic projections taken for an Operative Cholangiogram and where is the CR

A

AP scout
AP post injection
*LPO AND RPO optional

CR enters where the surgeon indicates over biliary ducts

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6
Q

Who is all involved with an Operative Cholangiogram

A

Surgeon: indicates centering, coordinates filming and injects contrast media (6-8 ml)
Anesthesiologist: stops pt breathing during x ray exposure
RT: takes x ray exposure to include an image of the biliary ducts full of contrast

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7
Q

Explain an ERCP

A

•Usually performed after an US
•A GI dr passes a fiber-optic endoscope (a duodenoscope) from mouth through esophagus and stomach into the duodenum. Then a catheter or small cannula is endeared through the scope into the opening o the sphincter of oddi into the duct of choice (biliary or pancreas) all performed under fluoro
•can be diagnostic or therapeutic
*can relieve pathological conditions such as choleliths or small lesions or repair a stenosis of the HP sphincter or ducts
* contrast can be injected via retrograde into ducts to open strictures and look for pathologies
•RT’s role is to set the room up for fluoro, assemble tray, draw up contrast, ask pt hx, take scout image and assist the GI dr with fluoro
•radiologists takes fluoro images

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8
Q

List 4 reasons a scout image is taken for any exam

A
  1. To determine correct positioning, tech factors, and centering
  2. To make sure pt is prepped properly
  3. To show to radiologist who looks for abnormalities and contraindications
  4. To localize anatomy of interest
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9
Q

List all advantages of Ultra sound vs OCG

A 
No ionizing radiation
Detects smaller calculi than OCG
Exam take less time
Quicker results or diagnosis
Noninvasive; no contrast involved
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10
Q

List advantages of Laparoscopy Cholangiogram vs Operative Cholangiogram

A

Less Hospital time less cost
Less scarring
Less recovery time
Less trauma to pt bc less invasive

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11
Q

What is the largest solid organ in the human body

A

Liver

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12
Q

What is the livers primary function

A

Produce bile

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13
Q

What pt position puts GB closest to the film

A

Prone

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14
Q

Describe GB position with pts body habitus

A

Hyperstenic (broad pt) GB higher an more lateral in right hypochondriac region
Sthenic/hyposthenic (average slightly skinny) GB 1/2 between xiphoid and lower rib margin
Asthenic (very skinny) GB low and medial next to vertebral column and near pelvis

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15
Q

List 2 laparoscopic studies performed with biliary system and give brief description

A

Laparoscopic cholecystectomy = surgical removal of the GB

Laparoscopic Cholangiography= surgical study of the biliary ducts

16
Q

For an IV Urogram list the obliques, tell why and tell what is seen the best with each Obl

A

30° LPO - left ureter and right kidney
30° RPO - right ureter and left kidney

Obl are done bc kidneys sit in a 30° oblique in the body; the 30° Obl position helps rotate the kidney to become parallel to IR

17
Q

List the 3 constricted points in a ureter

A 
Brim of pelvis ( iliac blood vessels cross over ureter)
Ureterovesical junction ( ureter joins under bladder)
Ureteopelvic junction (where renal pelvis and ureter joins)
18
Q

List the 3 common functions of the kidneys

A

Produce urine
Remove nitrogenous waste
Regulate acid-base balance and electrolyte levels

19
Q

How are the kidneys shaped and how do they sit in the body

A

Bean shaped
Sit at a 20-30° Obl with MSP
Upper pole sits at a 20°< and lies closer to the midline
Medial boarder is more anterior than lateral boarder

20
Q

List the renal artery system

A

Abdominal aorta, R&L renal arteries and capillaries

21
Q

Why is the basic functional unit of the kidney

A

Nephron

22
Q

List all words that mean void

A

Micturation
Urination
Excretion

23
Q

What does incontinence mean

A

The inability to control the urge to void

24
Q

Tell the difference between the male and female urethra

A

The male urethra is longer and larger in diameter and is used or passage of urine and semen

25
Q

List pt prep for an excretory urography

A

Liquid evening meal night before
Enema or latitude taken day before exam
NPO 8hrs
Empty bladder just prior to exam

26
Q

List the basic images taken for an excretory urography

A

AP scout KUB
1min nephrogram or nephrotimography or tomosynthesis
AP KUB at 5 min, 15 min
20 min 30° LPO and RPO
(Any other radiologist requests)
Post void image KUB or bladder shot either AP or PA

27
Q

List the centering point for posterior Obl for an IVU with a 10 x 12 and a 14 x 17 image

A

10x12 vertebral column (abt an 1” from MSP) and 1/2 between xiphoid tip and lower rib margin
14x17 vertebral column (abt 1” from MSP) and iliac crest

28
Q

List the basic images for a retrograde urography

A 
Scout AP KUB abd: after catheterization 
AP Pyelogram KUB: after urologist injects 3-5 mL of contrast directly thru catheter into renal pelvis of 1 or both kidneys
AP Ureterogram (KUB): when urologist indicates after he withdraws catherter and simultaneously injects contrast into one or both ureters
29
Q

List the CR angles for a cystography study

A

AP < 10-15° caudad, enter 2” above pubic symphysis
45-60° LPO & RPO : CR perpendicular and 2” above pubic symphysis and 2” medial to ASIS
Lateral: CR Perpendicular and 2” above pubic symphysis and posterior to ASIS

30
Q

List the images for a voiding cystourethrography

A
31
Q

Where is the adipose capsule and what is its importance

A

It surrounds the kidneys and protects them. It allows the kidney shadows to be seen on a KUB

32
Q

Where do the kidneys lie in the abd cavity

A

In the retroperitoneal space - upper posterior abd
1 on each side of vert column
1/2 between xiphoid and iliac crest
Upper pole - more posterior and closer to midline
Lower pole- more anteriorly

33
Q

What is the trigone

A

Triangular portion along inner posterior surface of bladder where the ureters enter and the urethra exits

34
Q

What is the importance of B.U.N. And creatinine lab results for an IVU and what are normal ranges for both

A

Diagnostic indicators of kidney function. To make sure kidneys can filter out contrast.
B.U.N. = 8-25mg/100 mL
Creatinine = 0.6-1.2 mg/dL ( in adult males ) and 0.5-1.1 mg/dL (in adult females) basically .5-1.5 textbook

35
Q

What position would be helpful if pt cannot have Ureteric compression for an IVU to achieve similar results?

A

15° trendelenburg

36
Q

How is contrast administered for a Urogram and a cystogram

A

Urogram : IV or catheter

Cystogram : catheter

37
Q

What urography study is performed on on males? Explain procedure and projection

A

Retrograde urethrography
A Brodney clamp is attached to the distal penis. Contrast media is injected retrograde into the distal urethra until the entire urethra is filled to demonstrate its full length.
30° RPO perpendicular to symphisis pubis 10x11 longwise

38
Q

Why is it important to determine if a pt is taking metaformin or a drug with a component of metaformin

A

Possible development of metaformin associated lactic acidosis in susceptible pt, therefore guidelines suggest metaformin be discontinued at time of procedure and withheld for 48 hrs after

Rad 112 (3 decks)

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