Quiz 5 Flashcards
What does an ERCP examine?
the biliary tree and the pancreatic duct system
What are the main ducts composing of the biliary tree?
- Right and Left hepatic ducts
- Common Hepatic duct
- Cystic duct
- Common Bile duct
If there is a tumor located in the pancreas, where is the best location due to ease of fixing it?
In the c-loop of the duodenum ( the tail end is harder to reach)
What is the endocrine function?
producing the hormones insulin and glucagon
What is the exocrine function?
producing digestive enzymes
What are indications for an ERCP?
Diagnostic
- Stenosis, dilation, obstruction or small lesions within the biliary or pancreatic duct
- Preoperative or postoperative procedure
- inconclusive gallbladder studies
Therapeutic
- Sphincterotomy may be performed to repair a stenosis of the sphincter of oddi or to facilitate stone removal from the bile ducts
- Stones can be removed either y threading a balloon catheter beyond the stone, inflating the balloon and then with drawing the balloon and stones into the duodenum or by using a basket catheter to retrieve the stone
- Biliary duct stenoses can be treated by dilation with a balloon catheter, by stent placement or by balloon dilation along with stent placement
- Pancreatic stones can also be removed by using either a balloon catheter or a stone basket for retrieval
What equipment is needed for an ERCP?
Imaging Equipment
- Fluoroscopic unit with a spot radiograph device
- Tilting table
Procedural Equipment ( Nurse normally brings)
- Patient monitoring device
- video equipment
- duodenoscope
- cannulae
- suction equipment
- medications, drugs and contrast agents (depends on place if you bring contrast or if they have it)
- injection materials
-
What is a duodenoscope?
an endoscope with a wide angle lens and side view capability, has a channel through its length through which a variety of cannulae or catheters may be advanced for diagnostic or therapeutic purposes; radiopaque tip
What are contraindications for an ERCP?
- Pancreatic pseudocysts
- Acute pancreatitis
- Septic cholangitis
How long does a patient need to be NPO for for an ERCP?
At least 4 hours
What is included in the preprocedural care for an ERCP?
1- Informed consent signed- procedure and related risks explained to the patient
2- Allergy history is reviewed- drugs and contrast agents for procedure are reviewed
3- Previous contrast reactions- patient should be premedicated according to protocol
4- NPO for at lease 4 hours before the procedure
5- Intravenous line inserted with normal saline or 5% detrose in water
What medications are needed for an ERCP?
- Xylocaine: topical anesthetic
- General anesthetic - for children and for patients unable to cooperate
- Injectable drugs - administered directly into the intravenous lines
- Sedatives - demeral, valium versed
- Versed - hypnotic effect, causing retrograde amnesia for a period of several hours post injection
- Oxygen
- Antispasmodic drugs - such as glucagon, this is given to relieve spasm of the duodenum and sphincter of oddi from the presence of the endoscope and cannula
- Narcan or mazicon - drugs that reverse the effectived of the sedatives
Who is the ERCP team?
1- Gastroenterologist - Endoscopist
2- Two nurses
3- Radiologist
4- Radiographer
During an ERCP, where is the patients head placed?
toward the foot end of the table
What position is the patient started in for an ERCP?
In a steep LAO until the patients throat is sprayed with anesthetic and medication is administered by the nurse and endoscopic tubing is passed through to the patients duodenum
Once the patient is in position within the duodenum, how is the patients position changed?
They are rolled down into a slight LAO or prone position
After the patients position is changed, what happens next?
The scope is manipulated until the papilla of vater is visualized face up
After the scope is manipulated until the papilla of the vater is visualized face up, what happens next?
The cannula is then threaded through the endoscope and inserted through the papilla opening and advanced into the appropriate duct system
Once the cannula is advanced into the appropriate duct system, what happens next?
Fractional injections of the contrast agent, under fluoroscopic control, guide and verify proper cannula placement
After verifying proper cannula placement, what happens next?
The contrast agent is injected and the appropriate spot films are taken
What kind of contrast media is used in an ERCP?
Water Based Iodinated contrast agents
1- Renographin M60 - Ionic
2- Isovue 300 - Nonionic
What is postprocedural care for an ERCP?
1- Recovery room- 1/2 hour for inpatients; 1 hour for outpatients
2- No food/fluids - sensation to the throat has returned
3- Vital signs monitored
What are complications of an ERCP?
1- Pancreatitis- very low incidence; less than 2%
2- Postprocedural infection caused by the rupture of pancreatic pseudocysts
3- Postprocedural cholangitis and septicemia caused by biliary obstruction
4- Reactions to drug administration
5- Perforation of the digestive tract by endoscopic equipment
What is the most common complication of an ERCP?
Perforation of the digestive tract by endoscopic equipment
