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The general term used to describe radiographic visualization of the biliary trach using a radiopaque contrast media
Study of the gall bladder(not common as ultrasound is taking its place)
Study of the bile ducts
Study of both the gall bladder and biliary ducts
Name the three methods by which contrast media can be introduced into the biliary?
- IV(IV cholangiogram)
- Direct injection( Percutaneous transhepatic cholangiogram)
- Indwelling drainage tube( Post operative injection into a T tube for cholangiogram)
What is the gold standard treatment for the removal of the gallbladder and its stones?
What are the advantages for a laparoscopic cholecystectomy?
- Less pain
- Faster recovery time
- Shorter hospitalization
- Smaller aesthetic incisions
- Cost savings
What is an E.R.C.P.
Endoscopic Retrograde Cholangiopancreatography
What structures are demonstraded in a ERCP
- Common bile duct
- Common hepatic duct
- Pancreatic duct
What is the procedure for an ERCP
- Patient sedated
- Fiberoptic endoscope is passed through mouth into duodenum under fluoro
- When hepatopancreatic ampulla is reached small cannula is placed in ampulla
- Radiographs performed
What kind of contrast is used in a ERCP
Water soluble - Iodated contrast
What veiws or projections are used to prevent superimpostion of the common bile duct and the pancreatic duct ?
Posterior oblique views
Why is speed mitigation factor in acquiring the best possible diagnostic radiographs durring an ERCP
Must be exposed immediately because the ducts will dreain the contrast within 5 min
What does PTC mean
Percutaneous Transhepatic Cholangiography
What are the indications for a PTC
- Patient with jaundice
- CT and Ultrasound demonstrated dilated ducts but fails to show the cause
- Used to place drainage catheter for the treatment of obstructive jaundice
What are the contradications that may occur for an PCT
- Increased clotting time
- Biliary tract infections
- Allergies to contrast
What complications that may occur with an PCT
- Liver lacerations
- Peritonitis from bile leakage (into peritoneal cavity)
What type of needle is used for an PCT
Chiba needle-skinny type
What are of the body is the puncture site for the skinny needle?
- Lateral abdominal wall into biliary ducts
- (RT costal space)
What devices may be used to remove a calculi
What are the radiographic images for an Operative (immediate) Cholangiography
- A.P projection( right upper quadrant)
- Right posterior oblique view
- 15-20 prevents the biliary from superimoposing with the spine
What view or projection is used to pervent the biliary from suoerimoposing with the spine
- RT posterior oblique view
- 15-20 prevent the biliary from superimoposing with the spine
Is a sterile required for a PTC
What area of the body is the injection site for the Skinny needle for a PCT
Right lateral intercostal space
In a PCT when are the ducts readily accessed by the needle?
When a calculi found on an image of a PCT what procedures can be done to improve the patients condition
- Retract retained stone -extraction
- Catheter left in place to drain fluid- decreased pressure- decrease pain
Can a chilba needle be used for the biliary drainage
No it is too small
What device is used to remove the calculi
- Wire basket
- Small ballon catheter
What will effectively separate the shadows of the gallbladder and vertebrae?
Rotate the patient into an oblique position
Which patient position would fill the intrahepatic ducts during an operating cholangiogram?
A percutaneous transhepatic cholangiogram is used for diagnosis of jaundice rather than as a treatment for obstructive jaundice
True or False
The spine should be included on images during an operative cholangiogram to ensure that all of the biliary ducts are demonstrated.
True or False
Air in the T-tube can simulate cholesterol calculi on the images acquired during a postoperative cholangiogram.
True or False
During an ERCP, the tip of a fiberoptic scope is placed in the
duodenum at the opening of the (Ampulla of Vater (Sphincter of Oddi)
When a percutaneous transhepatic cholangiogram is performed, the Chiba needle is inserted through the skin at the right ----so that it can be directed towards the---
- Lateral intercostal space
- liver hilum
The contrast media injected during an operative cholangiogram is introduced into the biliary ducts through a catheter placed into the---duct.
Common bile duct
The drainage tube should be clamped prior to the postoperative cholangiogram to prevent ---
Operative cholangiogram is used to investigate several possible conditions. State two of these.
- Patency of bile ducts and functional status of sphincter of oddi
- Reveal presence of calculi Intraluminal
- neoplasms and stricture or dilation of ducts
When would a PTC become a biliary drainage?
- Obstructive jaundice that cannot be resolved with stone removal
- Dilated ducts
Which ducts are cannulated during an ERCP?
Common bile duct and if possible pancreatic
What would you like to do?
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