Systems-Billary Tract Flashcards
What does Chole mean?
Bile
What does cysto mean?
Bag/sack/bladder
What does Cholecyst mean?
Gallbladder
What does coledocho mean?
Common bile duct
What does cholangio mean?
Bile vessel
What does lith mean?
Stone
Where is the gallbladder in hypersthenic patients?
2 inches higher than T12 and lateral
Where is the gallbladder in sthenic patients?
L2/1 inch above the LCM and 2 inches to the right of the MSP
Where is the gallbladder in asthenic patients?
Midline at L4 (illiac crest)
What are the 3 functions of the gallbladder?
- Storage of bile
- Consentration of bile
- Contraction when stimulated
When stimulated, what does the gallbladder secrete?
- CCK
- Bile
What is the function of bile?
Breaks down fats
Label 1-4
- Cystic duct
- Right hepatic duct
- Common hepatic duct
- Common bile duct
What is Cholecystography?
study of the GB
What is Cholangiography?
study of the biliary ducts
What is Cholecystangiography?
The study of GB & ducts
What are the 3 types of examinations of the billary tract?
- Percutaneous Transhepatic Cholangiography
- T-Tube Cholangiogram
- Endoscopic Cholangiopancreatogram – ERCP
What is cholelithiasis?
Cholelithiasis-Gall stones in the common bile duct
T/F
Cholesterol is radiolucent
True
T/F
Majority of gall stones are radiopaque
False; Majority of gall stones are radiolucent
What is the modalitly of choice for Cholelithiasis (Gallstones)?
Ultrasound is the modality of choice for diagnosis
What percentage of gallstones contain enough calcium to be seen radiographically?
20% contain enough calcium to be seen radiographically
How do we see gallstones if the majority are radiolucent?
See filling defect with contrast
What pathology is being shown here?
4 gallstones
What pathology is being shown in this image?
Filling defects with contrast, common bile duct enlarged
What pathology is being shown here?
Calcified gallstones
What does Percutaneous mean?
Percutaneous=Through the skin
T/F
PTC – Percutaneous Transhepatic Cholangiography is a theraputic proceedure only.
False; Diagnostic or therapeutic procedure
Where is the needle for PTC – Percutaneous Transhepatic Cholangiography inserted?
Into a bile duct
What is the purpose of PTC – Percutaneous Transhepatic Cholangiography?
- Injection of dilute contrast
- May drain excessive fluid
- May remove stones or sludge causing obstruction
What proceedure is often done for palliative patients?
PTC – Percutaneous Transhepatic Cholangiography
What is being shown here, what proceedure was done?
PTC w/ Chiba needle showing dilated biliary ducts
What is being shown here?
PTC with drainage catheter in place
What is PTC drainage often for?
Drainage often used for obstructive jaundice
What is the purpose of T-Tube Cholangiograms?
To show the caliber and patency of the ducts, or the presence of residual or previously undetected stones
What proceedure is this describing?
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
T-Tube Cholangiogram
What patient prep needs to be done prior to a T-Tube Cholangiogram?
- The drainage tube is clamped the day before
- The preceding meal is withheld
- May need cleansing enema 1 hour before
T/F
With a T-Tube Cholangiogram, you must ensure that there are no air bubbles.
True
Why is a pigtail catheter is required for laparoscopic biliary procedures?
A pigtail catheter is required for laparoscopic biliary procedures because it can be placed percutaneously.
What should the density of the contrast medium be for Biliary Duct Procedures? Why?
The density of the contrast medium used no greater than 25% to 30% because small stones may be obscured with a higher concentration
What is proceedure is being done?
T-Tube Cholangiogram
What is being shown here?
Filling defects of the billary tract
What is the lateral projection of the billary tract used for?
To show anatomic branching of the hepatic ducts in this plane and to detect any abnormality not otherwise shown
What does ERCP stand for?
ERCP - Endoscopic Retrograde Cholangiopancreatogram
Watch videos
http://www.youtube.com/watch?v=vnAtuG9ULB4
T/F
CT has now replaced msot ERCP - Endoscopic Retrograde Cholangiopancreatogram proceedures.
True
What is the main use for ERCP?
Treatment of choledocholithiasis and malignant obstructive jaundice
What proceedure is this describing?
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.
ERCP - Endoscopic Retrograde Cholangiopancreatogram
When is floro needed in ERCP?
Once the scope reaches the common bile duct
What body position should the patient be in for an ERCP?
They need to be in a lateral, recovery, or prone position. Just not supine.
What proceedure is being done here? What is circled in yellow?
ERCP, the pancreatic duct
What is this?
An endoscope
What are the responsibilities of the rad techs for imaging related to the billary tract?
- Set up examination tray
- Select and prepare contrast media,
- Take scout images
- Provide protective aprons
- Monitor the patient during the procedure
- Take conventional radiographs or fluoro images as requested
What is the arrow pointing to?
Catheter in the common bile duct
What is being shown here?
Cutting the sphincter of the oddie to let the stones in the common bile duct to come out
What proceedure has been done? What are the purple, yellow and green structures circled?
ERCP
Yellow: Common hepatic
Green: Cystic
Purple: Common bile
What is the most common modality for imaging of the gallbladder?
Ultrasound
What is the second most common imaging done for the gallbladder?
CT
Is this proceedure done with, or without contrast? What are the structures circled in purple and yellow?
CT scan done with contrast
Purple: Spleen
Orange: Gallbladder
What proceedure has been done here?
ERCP
What proceedure has been done here?
T tube
What proceedure has been done here?
Percutaneous Transhepatic Cholangiography
