ERCP Flashcards
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography
WHat
What parts of the anatomy does an ERCP examine?
Duodenum
Ampulla
Bile ducts
Gallbladder
Pancreatic duct
ERCP is used in diagnosing and treating the following conditions:
Blockage of the bile duct by gallstones, cancer, strictures (scarring) or compression from adjacent organs or tumors
Jaundice (yellow coloring of the skin)
Persistent or recurrent upper abdominal pain which cannot be diagnosed by other tests such as MRCP/MRI, CT
Confirming the diagnosis of cancer of the pancreas or the bile duct, so that surgery or other treatment can be tailored to the disease
When there is suspicion that the Sphincter of Oddi within the Papilla, that controls the flow of bile and pancreatic juice, is not working normally
In addition to being a tool to aid in diagnosis, ERCPs can also be therapeutic. Please name some procedures that we can perform…
Sphincterotomy
Stone Removal
Stent Placement
Balloon Dilation
What is a Sphincterotomy?
Sphincterotomy is cutting the muscle that surrounds the ampulla, which gives access into the common bile duct or the pancreatic duct. This cut is made to enlarge the opening. The cut is made while the doctor looks through the ERCP scope at the papilla, or duct opening. A small wire on a specialized catheter uses electric current to cut the tissue.
This small cut, or sphincterotomy, allows various treatments in the ducts.
What is the most common treatment through an ERCP scope?
The removal of bile duct stones
Why is a stent placed in the bile or pancreatic duct?
Stents are placed into the bile or pancreatic ducts to bypass strictures or narrowed parts of the duct. These narrowed areas of the bile or pancreatic duct are due to scar tissue or tumors that cause blockage of normal duct drainage.
Why would we balloon dilate during an ERCP?
The balloon is inflated to stretch out the narrowing. Dilation with balloons is often performed when the cause of the narrowing is benign (not a cancer). After balloon dilation, a temporary stent may be placed for a few months to help maintain the dilation.
Why do we require imaging prior to an ERCP? What types of imaging is typically done to determine the need for an ERCP?
ERCP has slightly higher risks such as exposure to pancreatitis. There are less invasive imaging studies available:
* CT
* EUS
* MRCP (MRI for the bile ducts)
What does a Liver Function test tell you?
Liver function tests are blood tests used to help diagnose and monitor liver disease or damage. The tests measure the levels of certain enzymes and proteins in your blood.
Some of these tests measure how well the liver is performing its normal functions of producing protein and clearing bilirubin, a blood waste product.
What are Bilirubin Levels?
Bilirubin is a yellowish substance that is created by the breakdown (destruction) of hemoglobin, a major component of red blood cells.
Bilirubin is released from the destroyed red blood cells and passed on to the liver. The liver excretes the bilirubin in fluid called bile.
What are high Bilirubin levels?
0.1-1.2 mg/dL is normal.
If bilirubin levels are higher than normal it may mean that the liver is not functioning correctly.
What are ALT & AST?
When liver cells are damaged or destroyed, the enzymes in the cells leak out into the blood, where they can be measured by blood tests. Liver tests check the blood for two main liver enzymes:
Aspartate aminotransferase (AST) – also found in muscles and many other tissues besides the liver. Normal AST levels are 8 to 48 U/L.
Alanine aminotransferase (ALT) – almost exclusively found in the liver. Normal ALT levels are 7 to 55 U/L.
