week 12- biliary system Flashcards
what types of procedures are used to image the biliary system, as well as operations? (7)
- Operative Cholangiogram (lap chole)
- ERCP Endoscopic Retrograde Cholangiopancreatography
- PTC Percutaneous Transhepatic Cholangiography
- CT
- MRI
- Plain X-ray
- Grahams Test (Rarely used)
what is retrograde and antegrade
Anterograde= moving with flow Retrograde = moving against flow
What major factors contribute to biliary disease
4 F's: Female Forty's Fat Fair skin
what variety of gallstones are there
- Cholesterol stones
- Pigment stones
- Mixed stones: contain cholesterol and salts
- Calcium stones
biliary system pathologies
Cholangitis Hepatic abscess Pancreatitis Biliary cirrhosis Jaundice
what is involved in a lap chole (why is it done and rads role)
Often done to remove a gallbladder
Radiographers role is to image the bile duct
-Imaging is done to show the “whole” length of the biliary tree
Lap chole:
how do you know where to position the II if pt is under sterile drapes?
Scopes point towards the biliary tree- position here
what are complications of a lap chole
- Reaction to the anaesthetic
- Bile leak into the abdomen
- Severing the Cystic Artery
- Post-surgical infection
- Accidental injury of the liver by the surgical instruments
- Pancreatitis
- Reaction to Contrast
what are some indications of an ERCP
Bile duct stones
Strictures
Tumours
Pancreatic pathologies
Stenting of the C.B.D.
Sphincterotomy to extract stones
contraindications of an ERCP
- Iodine allergy
- Complications with anaesthetic
- Heart failure
- Pregnancy
what is the procedure of
ERCP
Patient is R side up prone on the fluoroscopy table
The gastroenterologist inserts the endoscope into the mouth guard
Patient gags/resists the scope. Patient is partially anaesthetized to be able to swallow
The Radiographer positions the I.I. over the bile duct area. Once the tube is in place, “screen” to see if the tube is in the correct position
X-rays are taken as the catheter is moved into the duct, and contrast injected
Radiographer must document the procedure imaging each stage
what is Percutaneous trans-hepatic cholangiogram (PTC)
A “long” needle is inserted into the R hepatic bile duct via the liver
what are some indications for Percutaneous trans-hepatic cholangiogram (PTC)
Failed ERCP
ERCP is not possible due to obstructive pathology or unable to tolerate the endoscope
Biliary system has is obstructed with calculi preventing catheterisation via ERCP method
what are some complications for Percutaneous trans-hepatic cholangiogram (PTC)
Allergic reaction to contrast
Bleeding inside the Liver from needle puncture
