is pear-shaped sac, composed of three-parts fundus, body and
neck. 7 10 cm long, 3 cm wide and normally holds 30 to 40ccs of
bile.
Slide 4
store and concentrate bile and contract when stimulated. Bile
is concentrated w/in the gallbladder due to hydrolysis. Gallbladder
normally contracts when foods such as fats or fatty acids are in
duodenum.
Slide 5
Right & Left hepatic ducts Common hepatic duct Cystic
duct
Slide 6
Chole bile is a bitter yellowish, blue and green fluid secreted
by hepatocytes from the liver. Cysts- is a closed sac having a
distinct membrane and division on the nearby tissue Angio refers to
the arteries or veins or blood vessels
Slide 7
Cholecystography Radiographic examination specifically of the
gallbladder. Cholangiogram radiographic examination of the biliary
ducts. Cholegraphy general term used to denote specialized exam. Of
the biliary ducts. Cholecystocholangiogram examination of the
gallbladder and biliary ducts. Cholecystopaques(OCG) termed for
visulaization of the gallbladder by the used of contrast
media.
Slide 8
by mouth (oral) by injection into a vein in a single bolus or
drip infusion (intravenous) by direct injection into the ducts ;
through percutaneous transhepatic puncture during biliary tract
surgery (operative or immidiate) through an indwelling drainage
tube ( post- operative, delayed, or T-tube)
Slide 9
Each method of examination is named according to; The route of
entry of the medium The portion of the biliary tract examined
Slide 10
Slide 11
Is a non-invasive radiographic procedures that is used if a
inconclusive ultrasound report. It is a simple, economical and
least invasive and highly effective method of investigating the
gallbladder problems The route of entry is by mouth.
Slide 12
Purpose: Study radiographically the anatomy and function of the
biliary system. Function: It measures the functional ability of the
liver to remove the orally administered contrast medium from the
blood stream and to excrete it along with the bile.
Slide 13
Advanced hepatorenal disease, those with renal impairement.
Active gastrointestinal disease such as vomiting or diarrhea, which
would prevent absorption of oral contrast medium. Hypersensitivity
to iodine containing compound.
Slide 14
Neoplasm Biliary stenosis narrowing of the biliary ducts
Congenital anomalies Cholelithiasis condition of having gallstone.
Cholecystitis inflammation and blockage of the cystic duct
restricts the flow of bile into the cbd due to stones.
Slide 15
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Slide 18
Preliminary Diet 1. an evening meal that is fat free to prevent
the possibility of emptying the gallbladder. 2. A noon meal that is
rich in simple fats and an evening meal that is free of fats. Oral
media are usually administered about 3- hrs after evening meal.
Nothing by mouth. Breakfast is usually withheld in all
methods.
Slide 19
Consisted of a commercially available bar or eggs and milk or
eggnog. It is important to have a fatty meal as to serve as
stimulant for the gallbladder. Without the fatty meal we cannot
observe the function of the gallbladder empting its bile's.
The intestinal mucosa in absorbing the contrast substance and
liberating it into the portal bloodstream for conveyance to the
liver. The liver in removing the opaque substance from the blood
and excreting it with the bile. The GB in concentrating the
opacified bile by removing 90% water content in storing the
concentrated bile during interdigestive period.
Slide 22
Slide 23
Demonstrates the biliary ducts to determine if an obstruction
exists due to calculi or other pathology. Is employed in the
investigation of; Biliary ducts of cholecystectomized patients. The
biliary duct and gallbladder of non- cholecystectomized
patients.
Slide 24
Laxative Restricted diet Enemas Breakfast is withheld
Slide 25
10 min. timed from the completion of the injection until
satisfactory visualization. 30 40 min. maximum pacification.
Slide 26
Not indicated for patients who have liver disease or for those
whose biliary ducts are not intact.
Slide 27
Slide 28
Another type that demonstrate the biliary ducts. More invasive,
but it gives the radiologist more options in the diagnosis and
treatment of biliary conditions. Involves direct puncture of
biliary ducts with needle.
Slide 29
is caused by an interruption to the drainage of bile in the
biliary system. The most common causes are gallstones in the common
bile duct, and pancreatic cancer in the head of the pancreas
Slide 30
Slide 31
Prepare the fluoroscopic suite Set-up the sterile tray and
include the long, thin-walled needle used for puncture. Select and
prepare the contrast media. Take the appropriate scout films to
verify position and technique. Monitor the patient during the
procedure. Change fluoro-spot films as needed.
Slide 32
Slide 33
Perform during surgery and cholecystectomy. Introduced by
mirizzi in 1932. Used in the investigation of the patency of the
bile ducts and of functional status of the sphincter of
hepatopancreatic ampulla to reveal the presence of calculi.
Slide 34
Investigate the patency of the biliary tract. Determine the
functional status of the hepatopancreatic ampulla. Reveal any
choleliths not previously detected. Demonstrated small lesions,
strictures or dilations within the biliary ducts.
Slide 35
Obstructive jaundice Cholangiocarcinoma Stones in the biliary
passages Strictures of common bile ducts Choledochal cysts
Slide 36
Slide 37
Slide 38
Radiologic terms applied to the biliary tract examination that
is determined by way of the T shaped tube left in CBD for
postoperative drainage.
Slide 39
Performed to demonstrate the caliber and patency of the ducts.
The status of the sphincter of the hepatopancreatic ampulla.
Presence of residual or previously undetected stones or other
pathologic conditions
Slide 40
Drainage tube is clamped the day preceding the examination to
let the tube fill with bile as preventive measure against air
bubbles entering the ducts. The preceding meal is withheld. When
indicated, a cleansing enema is administered about an hour before
the examination.
Slide 41
Is one of the water-soluble, organic contrast media. 25 30%
density of contrast medium is used.
Slide 42
Patient must have T-tube patient's with possibility of residual
small gallstones post cholecystectomy obstructive jaundice bile
duct stricture surgeon unable to explore bile duct during
cholecystectomy surgery
Slide 43
non-consent by patient to procedure contrast or iodine allergy
pregnancy (? pregnancy test required) barium study within last 3
days
Slide 44
RPO with the right upper quadrant of the abdomen is centered to
the midline of the table. Stern stress the importance of obtaining
a lateral position to demonstrate the anatomic branching of the
hepatic ducts and to detect any abnormality.
Slide 45
The patient is positioned supine on the x- ray table A slightly
RPO position can help to ensure the CBD is not superimposed over
the patient's spine. A preliminary/scout image of the RUQ should be
acquired. The tip of the t-tube is cleaned with antiseptic the
t-tube should be raised and tapped to ensure there are no air
bubbles lurking in the tube.
Slide 46
A butterfly needle should be inserted into the T-tube The
syringe plunger is withdrawn to remove bile from within the duct.
(optional) An early filling image should be obtained. The entire
biliary tree should be imaged during injection of contrast
medium.
Slide 47
Injection should continue until the entire biliary tree is
opacified and there is passage of contrast into the deuodenum. If
the intrahepatic ducts do not fill, the patient can be tilted
trendelenburg and further contrast injected into the T-tube. The
patient may need to lie on their left hand side to fill the left
hepatic duct. At least 2 views of the entire biliary tree should be
recorded by spot film, oblique views are often taken
Slide 48
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Slide 53
Procedure used to diagnose biliary and pancreatic pathologic
conditions. Where a catheter is passed through the hepatopancreatic
ampulla and a contrast media is injected in a retrograde fashion
into the biliary ducts.
Slide 54
1. Investigate the patency of the biliary/pancreatic ducts. 2.
Reveal any choleliths not previously detected. 3. Demonstrate small
lesions, strictures or dilatations within the biliary/pancreatic
ducts.