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AP 2 - Book
Lecture 10 - Biliary System
| Question | Answer |
|---|---|
| General terms used to describe examinations of the Biliary System | Cholography |
| Why is the use of Contrast Medium necessary when performing exams of the Biliary System? | Because the Gallbladder and Biliary Ducts are of the same density as the surrounding tissue |
| Examinations of the Biliary System are named according to what? | The portion of the Biliary Tract to be examined |
| Chole refers to? | The Biliary System |
| Cysto refers to? | The Gallbladder |
| Angio refers to? | The Bile Ducts |
| Contrast media used to demonstrate the Biliary System? | Water-Soluble Iodinated contrast media |
| The routes used to administer the contrast medium for examinations of the Biliary System 1. 2. | 1. Oral - previously performed 2. Direct Injection into the Ducts - The only route used today to image the Biliary System in Diagnostic Radiology |
| In the past, contrast medium was ingested orally to demonstrate the Gallbladder radiographically, this examination was called? | An Oral Cholecystogram or OCCG |
| The contrast medium for a past form of demonstrating the Gallbladder called a Cholecystogram, used a contrast medium in the form of ______ ______, containing _____% organically bound iodine that were insoluble in water | Oral Tablets; 66 |
| Today, what is the modality of choice for examination of the Gallbladder? | Ultrasound |
| Ultrasound uses ______ ______ to visualize the Gallbladder | Sound waves |
| The advantages of Ultrasound Imaging of the Gallbladder are: 1. 2. 3. 4. 5. | 1. no ionizing radiation 2. Can detect small Biliary Calculi in the Gallbladder/Biliary Ducts - were not visualized before 3. No contrast medium required 4. Less patient prep 5. Can correlate radiographic findings on diagnostic images of the Abdomen |
| What are the three examinations performed by direct injection of contrast medium into the Biliary Ducts in Diagnostic Radiology? | 1. ERCP 2. Percutaneous Transhepatic Cholangiogram 3. T-Tube Cholangiogram |
| Surgical Procedure of the Biliary System where contrast medium is injected directly into the Biliary Tree | Operative Cholangiogram |
| A radiographic and fluoroscopic procedure that visualizes the Biliary Tree by direct injection of contrast medium into the Biliary Ducts through an Endoscope | Endoscopic Retrograde Cholangio-Pancreatogram (ERCP) |
| An alternative procedure for patients who are unable to have an ERCP - Contrast Medium is directly injected into the Porta Hepatis of the Liver by a specialized needle to visualize the Biliary Ducts | Percutaneous Transhepatic Cholangiogram (PTC) |
| A Post-Operative radiographic and fluoroscopic procedure performed after Cholecystectomy (Gallbladder removal) surgery | T-Tube Cholangiogram |
| Where is the T-shaped Tube placed for a T-Tube Cholangiogram and Why? | Through the remaining Cystic Duct, into the Common Hepatic Duct and Common Bile Ducts; to keep them patent or open following surgery and injected with contrast medium to determine if any residual gallstones are present |
| What procedure is performed in surgery either before or after the removal of the Gallbladder (Cholecystectomy)? | Operative Cholangiogram |
| Inflammation of the Gallbladder and what causes it? | Cholecystitis; in most cases, caused by Gallstones that block the Biliary Tree (build-up of bile) |
| What can Cholecystitis lead to if left untreated? | A Gallbladder that becomes enlarged or ruptures |
| The presence of Calculi or stones in the Biliary Ducts that sometimes migrate from the Gallbladder? | Choledocholithiasis |
| Stones often produce a blockage in the ducts causing a condition known as? | Biliary Colic |
| Where does pain frequently begin if a patient has Biliary Colic? | In the Epigastric region and then localizes to the RUQ - may radiate to the right shoulder or Scapula |
| The presence of stones in the Gallbladder | Cholelithiasis |
| Of all Gallbladder and Biliary Duct disorders, what percentage are due to Gallstones? | 90% |
| Approximately 60% of gallstones are composed of Cholestrol, making them ________ | Radiolucent |
| Only a small percentage of gallstones are composed of ______ ______ ______, which make them visible on an abdominal image without contrast medium | Crystalline Calcium Salts |
| Gallstones can range in size from as small as a ______ of ______ to as large as a ______ ______ | Grain of sand; golf ball |
| Risk Factors of Gallstones: 1. 2. 3. 4. 5. 6. 7. 8. 9. | 1. Female 2. 60+ 3. Obesity 4. Pregnancy 5. Poor Nutrition 6. Family History 7. Diabetes 8. Cholesterol-lowing medications 9. Medications that contain estrogen (hormone therapy drugs) |
| Complications of gallstones may include: 1. 2. 3. 4. | 1. Cholecystitis 2. Biliary Stenosis or blockage of bile ducts (resulting in jaundice and infection) 3. Pancreatic Duct blockage, resulting in Pancreatitis |
| A common treatment for gallstones either through open abdmominal or laproscopic surgery | Cholecystectomy |
| True or False? Gallbladder Cancer is very rare | True |
| About 9 out of 10 gallbladder cancers are __________, with a small percentage being ______ ______ ______ | adenocarcinomas; squamous cell carcinomas |
| Metastasis is often part of the having gallbladder cancer due to? | The Gallbladder's close structural relationship with the Liver |
| Not an illness in itself, but a medical condition in which too much bilirubin - a compound produced by the breakdown of hemoglobin from red blood cells, is circulating in the blood. | Jaundice |
| What is the result of excess bilirubin? | The skin, eyes, and mucus membranes in the mouth to turn a yellowish color |
| Three main types of Jaundice: 1. 2. 3. | 1. Hepatocellular Jaundice 2. Hemolytic Jaundice 3. Obstructive Jaundice |
| A type of Jaundice that occurs as a result of Liver disease or injury | Hepatocellular Jaundice |
| A type of Jaundice that occurs as a result of hemolysis (an accelerated breakdown of erythrocytes - red blood cells) leading to an increase in production of bilirubin | Hemolytic Jaundice |
| A type of Jaundice that occurs as a result of an obstruction in the Biliary Ducts, which prevents bilirubin from leaving the Liver. | Obstructive Jaundice |
| An accelerated breakdown of erythrocytes (red blood cells) | Hemolysis |
| Laboratory tests to confirm the diagnosis of Jaundice include: 1. 2. 3. 4. | 1. Liver function test 2. Bilirubin blood test 3. Complete Blood Count (CBC) 4. Hepatitis A, B, and C tests |
| A radiographic and fluoroscopic procedure that visualizes the Biliary Tree by direct injection of Water-Soluble Iodinated contrast medium into the Biliary Ducts through an Endoscope - Joint procedure between Radiology and Gastroenterology departments | Endoscopic Retrograde Cholangio-Pancreatogram (ERCP) |
| During an ERCP procedure: an Endoscope is inserted through the mouth into the ______ ______ A small Catheter (cannula) attached to the endoscope is placed into the ______ of ______ - Contrast medium is injected through the catheter in what fashion? | Descending Duodenum; Ampulla of Vater; Retrograde |
| Procedure that can be performed as a therapeutic procedure to remove a cholelith or small lesion in the Biliary Duct - can also be performed to repair a stenosis of the Sphincter of Oddie or an associated duct? | ERCP |
| Clinical Indications for performing an ERCP: 1. 2. 3. 4. | 1. Cause of Obstructive Jaundice 2. Rule out a Cholelith Obstruction of the Biliary Tree 3. Unexplained Biliary Colic 4. Lesions, Strictures or Dilations of the Common Bile Duct and/or Pancreatic Duct |
| An ERCP is usually performed after Ultrasound, CT, or MR imaging when what has been diagnosed? | An abnormality of the Common Bile Duct or Pancreatic Duct |
| Contraindications to performing an ERCP include: 1. 2. 3. 4. 5. | 1. Hypersensitivity to Water-Soluble Iodinated Contrast Media 2. Infection of the Biliary System 3. Pseudocyst of the Pancreas 4. Acute Pancreatitis 5. Elevated Creatinine or BUN levels |
| What is the patient assessed for prior to receiving Water-Soluble Iodinated Contrast Media? 1. 2. 3. 4. | 1. Allergies to food/medication 2. History of Asthma 3. History of Iodinated Contrast reactions 4. Cardiac or Renal impairment 5. Creatinine and GFR lab results reviewed by tech or Radiologist in patient chart |
| GI Preparation prior to an ERCP examination: 1. 2. 3. | 1. NPO after midnight of the day of exam 2. Food and fluids withheld for at least 8 hours 3. No smoking or chewing gum during the NPO period (increases gastric secretions and salivation - could prevent proper coating of barium to gastric mucosa) |
| Articles Necessary for an ERCP exam: 1. 2. 3. 4. 5. 6. 7. | 1. Suction equipment if necessary 2. 20 cc syringe - contrast injection 3. Local anesthetic spray - insertion of Endoscope 4. Emesis basin 5. Sterile Gloves and Sterile Drape 6. Lead apparel (radiology/GI staff) 7. IR's for Overheads (upon request) |
| Fluoroscopic Equipment Preparation ERCP exam: 1. 2. 3. 4. 5. | 1. Place X-ray Table in Horizontal position 2. Place Bucky Slot Cover Shield over opening in side of table 3. Reverse the Fluoro image on the Image Intensifier 4. Enodoscopy staff - will set up for the Endoscope 5. Patient's Head placed at foot end |
| Fluoroscopic Equipment Preparation cont'd....... 6. 7. 8. | 6. Attach footboard at head end of the table 7. Position bucky tray at the head end of the table, lock in place 8. Place Fluoro foot pedal and TV Monitor in position (tech use, will fluoro upon request of Gastroenterologist during Endoscope insertion) |
| Fluoroscopic Equipment Preparation cont'd........ 9. 10. 11. | 9. Set Control Panel for Fluoro - including setting the fluoro timer for 5 minutes 10. Enter patient information (name, MRN, DOB, Radiologist name, and exam to be performed) 11. 80-90 kV used for Water-Soluble Iodinated Procedures |
| Patient Preparation for an ERCP exam: 1. 2. 3. 4. | 1. Admitted to Same Day Surgery - premedicated with sedative (Valium) prior to arrival in Radiology 2. accompanied by GI Lab Staff (Provide endoscopy equipment and med supplies) 3. GI nurse insert IV line 4. Blood pressure and Oxygen monitored by nurse |
| Patient Preparation - Rad Tech will: 1. 2. 3. 4. | 1. Prior to Fluoro procedures, assist the GI staff 2. Provide additional supplies as needed 3. Assist in drawing up contrast medium 4. Perform a SCOUT AP upon request of Radiologist or Gastroenterologist |
| The Fluoroscopic procedure begins with the patient lying in what position? | Left Lateral |
| During an ERCP Procedure, why is the patient's throat anesthetized with Xylocaine spray? | To temporarily paralyze the Pharynx and depress the gag reflex when the Endoscope is inserted |
| Where is the cannula placed in preparation for the syringe filled with contrast to be injected? | Ampulla of Vater |
| Which two ducts are selectively catheterized and filled with contrast media during the ERCP procedure? | Common Bile Duct and Pancreatic Duct |
| Overhead Projections performed on the Biliary Tree include: 1. 2. | 1. RPO (most important) 2. AP or PA Projection |
| Why is the RPO position the most important Overhead performed in an ERCP exam? | it facilitates drainage of the Biliary Ducts |
| Gallbladder is located in the lateral RUQ, higher in the Abdomen, round in shape | Hypersthenic |
| Gallbladder is located midway between the spine and right lateral abdominal wall at the level of the Elbow, opposite L2 | Sthenic |
| Gallbladder lies lower in the Abdomen, close to the Spine | Hyposthenic |
| Gallbladder lies near the pelvis at approximately L4-L5, overlying the spine | Atshenic |
| Post-exam after an ERCP, why does the patient need to remain NPO for at least 1 hour after the exam? | Due to Pharyngeal paralysis to avoid aspiration into the lungs |
| Procedure that may be performed before or following surgical removal of the Gallbladder - Surgeon places a small catheter into the biliary ducts and injects contrast while tech operates C-arm as directed. | Operative Cholangiogram |
| Type of contrast media used for an Operative Cholangiogram? | Water-soluble Iodinated Contrast Media |
| When is a T-Tube Cholangiogram performed? | Post-Cholecystectomy to investigate the T-Tube within the Biliary Ducts using Fluoro |
| What type of contrast media is used for a T-Tube Cholangiogram? | Water-soluble Iodinated Contrast Media |
| Clinical Indications for a T-Tube Cholangiogram: 1. 2. 3. | 1. visualization of residual gallstones in Biliary Ducts 2. Investigate Patency (Open) of the Biliary Ducts 3. Removal of T-Tube if Biliary Ducts are free of residual stones |
| Preparing the patient for the Exam: 1. The day prior..... 2. Patient is admitted to..... and will receive........ 1 hour prior to exam 3. patient undressed from..... 4. Explain...... obtain.... 5. Perform..... if requested | 1. T-Tube is clamped off 2. SDS; cleansing enema 3. waist down, gown tied in front 4. procedure; history 5. 35-40 degree RPO SCOUT |
Created by:
teresachristensen
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