narrowing of bile ducts
Biliary stenosis
acute or chronic inflammation of the GB
Cholecystitis
presence of gallstones
Cholelithiasis
- general term for radiographic study of the biliary system
Cholegraphy
- radiographic investigation of the GB
Cholecystography
- radiographic investigation of the biliary ducts
Cholangiography
radiography of both the gallbladder & biliary ducts
Cholecystangiography or cholecystocholangiography
relationship with bile
Chole
bag or sac
Cysto
common bile duct
Choledocho
bile ducts
Choloangio
gallbladder
Cholecyst
hormone that stimulates the contraction of gallbladder
Cholecystokinin
IR: 18x24cm
Ppx: prone; erect
Pp:
Prone:
- right side of abdomen centered
- rest head on left cheek – to rotate the vertebrae slightly toward to the left
Erect:
- center gallbladder
- used to demonstrate the mobility of the gallbladder
- detect the presence of stones that are too small to cast individual shadows
- differentiate papilloma or other tumor shadows from cholesterol calculi shadows
CR: perpendicular
PA PProjection
IR: 18x24cm lengthwise
Ppx: recumbent for oblique & lateral projections
Pp: LAO position
- prone
- elevated right side (15-40°)
CR: perpendicular
Instruction – end of exhalation
PA Oblique LAO
- used to differentiate gallstones from renal stones or calcified mesenteric lymph nodes
- used to separate the superimposition of the gallbladder & the vertebrae
IR: 18x24cm lengthwise
Ppx: recumbent for oblique & lateral projections
Pp: Lying on the right side
Right Lateral Position
- used to demonstrate:
o stone that are heavier than bile & that are too small to visible other
than when accumulated in the dependent portion of the gallbladder
o stone that are lighter than bile & that are visualized only by stratification - used for patient who cannot stand for an erect position
IR: 18x24cm
Ppx : lateral recumbent
Pp: body elevated 2 to 3 inches on a suitable support
CR: horizontally
AP Projection
R lateral decubitus
position
- used primarily to draw the gallbladder superiorly, where it will not superimpose
by the intestinal contents
Ppx: upright
Pp: - right side of abdomen centered to VGCH
- patient to grasp the sides of the stand or table
- brace abdomen against grid or table
- lean thorax posteriorly in a forced lordotic position
Location of gallbladder: - 8th rib or L2 & L3 – right side
o place film 1-2” away from the vertebral column - obese – 2-3” higher than the normal
- thin – 2-3” lower than the normaltion
Inspiration – downward medially
Expiration - upward laterally
PA Lordotic Projection
Purpose:
- investigate biliary ducts & gallbladder of noncholecystectomized patients
- when the structures are not visualized by OCG
- patient cannot take orally the CM due to vomiting or diarrhea
- investigate biliary ducts of cholecystectomized patients
INTRAVENOUS CHOLANGIOGRAPHY
- preoperative exploration of biliary tract
- used for patients w/ jaundice when the ductal system has been shown dilated by CT or ultrasonography but cause of obstruction is unclear
- patient right side surgically prepared & appropriately drapped – CM inserted through a Chiba needle into the right lateral intercostal space &
advance toward the liver hilum - patient under local anesthesia
- procedure done under fluoroscopy – serial or spot AP projections
PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC) OR
TRANSABDOMINAL CHOLANGIOGRAPHY
- carried during biliary tract surgery
- following drainage of the bile, & in the absence of obstruction, CM is introduced into the major intrahepatic ducts as well as the extrahepatic ducts.
OPERATIVE (IMMEDIATE) CHOLANGIOGRAPHY
examination performed by way of the T-shaped tube left in the common bile duct (CBD) for postoperative drainage
POSTOPERATIVE CHOLAGIOGRAPHY
(delayed or T-tube cholangiography)
- Surgicoradiologic procedure wherein a water-soluble, iodinated CM is introduced into the main pancreatic duct (duct of Wirsung) for investigation of the pancreas
- Done by:
o efflux filling from an injection made into the CBD when these two passages share a common channel before emptying into the duodenum
o direct injection through the transduodenal catheterization of the duct - MSP centered to grid at level of xiphoid process
PANCREAS: OPERATIVE PANCREATOGRAPHY
- use to diagnose the biliary & pancreatic pathologic conditions
- useful diagnostic method when the biliary ducts are not dilated & when no obstruction exists at the ampulla
- performed by passing a fiber-optic endoscope through the mouth onto the duodenum under fluoroscopic control
o to ease passage of endoscope – patients throat sprayed w/ local anesthesia - causes temporary pharyngeal paresis
o food & drink usually prohibited for at least 1hr after the procedure - food w/held for up to 10 hrs after procedure
o minimize irritation to the stomach & small bowel - Endoscopist locates the hepatopancreatic ampulla (ampulla of Vater)
o small cannula is passed through the endoscope & directed into the ampulla
o CM injected into the CBD - Oblique radiographs taken to prevent overlap of the CBD & pancreatic duct
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
