1
Q
This is manufactured by the liver, transported by various ducts, and stored in the gallbladder
A
bile
2
Q
Consists of organs and ducts that are involved in the production and transportation of bile such as gallbladder, bile ducts, and other associated structures
A
biliary system
3
Q
The largest solid organ in the human body and weighs 3 to 4 lbs (1.5 kg) in an average adult.
A
liver
4
Q
where is liver located?
A
RUQ
5
Q
how much does liver secretes bile per day?
A
800 - 1000 mL
6
Q
How many functions does liver performs?
A
more than 100
7
Q
What organ is a pear-shaped sac that is composed of three parts: fundus, body, neck?
A
gallbladder
8
Q
What is the distal end and the broadest part of gallbladder?
A
fundus
9
Q
what is the main section of gallbladder?
A
body
10
Q
what is the narrow proximal end of gallbladder, which continues as the cystic duct?
A
neck
11
Q
cystic duct is _____ long and contains several membranous folds along its length
A
3 - 4 cm
12
Q
this prevent distension or collapse of the cystic duct
A
spiral valve
13
Q
what is the approximate size of a normal gallbladder?
A
7 - 10 cm long
3 cm wide
14
Q
how much bile does gallbladder can generally holds?
A
30 - 40 mL
15
Q
3 functions of gallbladder
A
- store bile
- concentrate bile
- contract when stimulated
16
Q
- When the liver cells secrete bile, it is collected by a system of ducts that flow from the liver through the ___ and ___.
A
right and left hepatic ducts
17
Q
- The right and left hepatic ducts will ultimately drain into the ______.
A
common hepatic duct
18
Q
- The common hepatic duct then joins with the ___ from the gallbladder to form the common bile duct, which runs from the liver to the duodenum
A
cystic duct
19
Q
5 Causes of absence of contrast media in the gallbladder
A
- Functional disturbance of the patient
- Surgically removed
- Patient vomited the contrast media or had diarrhea
- Contrast media ingested too late
- Improper patient preparation
20
Q
what is the surgical removal of gallbladder?
A
cholecystectomy
21
Q
what is the surgical cutting into the gallbladder?
A
cholecystotomy
22
Q
what is the procedure of making an opening between the gallbladder and small bowel?
A
cholecystoenterostomy
23
Q
what is the procedure of making an opening between gallbladder and duodenum?
A
cholecystoduodenostomy
24
Q
Pathologic indications in biliary system
A
- Cholecystitis
- Gallbladder cancer
- Strawberry GB – (GB cholesterolosis)
- Cholelithiasis
- choledocolithiasis
25
inflammation of gallbladder
cholecystitis
26
a growth of malignant cells that begins in the gallbladder
gallbladder cancer
27
a change in GB wall due to excess cholesterol
strawberry gallbladder
28
hardened pieces of bile that form in your gallbladder or bile ducts
cholelithiasis
29
presence of gallstones in the common bile duct
choledocolithiasis
30
contraindications in biliary system examination
1. Patient with severe hepatorenal disease
2. Iodine sensitivity
3. Pregnant
4. Dehydration
31
7 Special radiographic procedures to examine the biliary system
1. Oral Cholecystography (OCG)
2. Intra-Venous Cholangiography (IVC)
3. Percutaneous Trans-hepatic Cholangiography (PTC)
4. Endoscopic Retrograde Cholangiopancreatography (ERCP)
5. Immediate or Operative Cholangiography (IOC)
6. Delayed or Post-Operative T-Tube Cholangiography
7. Chole-GIS
32
hindi ko ilalagay lahat ng keme keme ng projections, reviewhin mo sa module letse ka
like kung pano position ng patient at everything, bahala ka na magbuklat lintik
33
indications for oral cholecystography (OCG)
1. To determine the function of the liver, its ability to remove the contrast media from the blood stream and excrete it with bile.
2. To determine the patency of the biliary ducts.
3. To evaluate the concentrating and emptying power of the gallbladder.
4. Calculi
5. tumor
34
patient preparation of OCG
1. Soft diet for 2 days prior to examination
2. Plain abdomen a day prior to examination
3. Fatty meal for lunch, a day prior to examination
4. Light supper consisting of non-fatty foods a day prior to examination
5. Laxative may be given if not contraindicated one hour after evening meal
6. Telepaque/biloptine tablets is administered in not less than 10-12 hours prior to examination
7. NPO after taking contrast media
8. No breakfast
35
how is biloptine administered?
* Single dose – 6 tablets or 1 tablet/5 min interval
* Double dose – 12 tablets or 2 tablets/5min interval
36
what is the projection of the localization film of OCG?
AP projection
37
what are the series film of OCG?
- RAO projection
- PA
- LPO
- PA upright
- Right lateral decubitus
- Left lateral (recumbent)
38
what is the main CR and RP in OCG?
cr is perpendicular to the gallbladder
39
what are the modifications in OCG?
- trendelenburg maneuver
- fleischneu's modification (reverse limblom position)
40
what is the structure shown in Trendelenburg maneuver?
separation of the gallbladder from gas shadow in the hepatic flexure
41
what is the structure shown in Fleischner's modification?
separate gallbladder shadow from hepatic flexure or iliac crest in asthenic patient
42
This is done to evaluate contracting and emptying power of the gallbladder.
post motor to evaluate contracting and emptying power of gallbladder
43
This special procedure is only requested if there is no visualization of the gallbladder in the oral cholecystography.
intravenous cholangiography (IVC)
44
What are the indications in IVC?
1. Demonstrates biliary ducts and cholecystectomized subject
2. Demonstrates biliary ducts and gallbladder for non-cholecystectomized subject
3. Choledocholithiasis
4. Acute cholecystitis
45
what is the localization film in IVC?
AP projection
46
what are the series film in IVC?
AP projection
RAO projection
47
- This examination is usually performed for the immediate or pre-operative investigation of a patient with jaundice thought to be of obstructive origin.
- It is used to differentiate between extrahepatic biliary obstruction and intrahepatic choliectasis.
PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)
48
The injection of contrast medium is made into one of the intrahepatic bile ducts, using a _____
Chiba needle
49
what is the size of Chiba needle?
15 cm long
23 F gauge
30 bevel angle
50
what are the associated risk in doing PTC?
* Liver hemorrhage
* Pneumothorax
* Escape of bile
51
indications in PTC
1. Extrahepatic biliary obstruction
2. Intrahepatic biliary obstruction
52
contraindications in PTC
1. Patient who have a tendency of bleeding
2. Biliary tract infection
3. Allergy to contrast medial
53
patient preparation in PTC
1. Prophylactic antibiotic is given, commencing 24 hours before examination and continuing for 3 days afterwards
2. NPO for 6-8 hours
3. No breakfast
54
what projection of the preliminary film in PTC?
AP projection
54
after care in PTC
* The patient must be under constant investigation for 48 hours for any signs of hemorrhage, bile leakage, pneumothorax, or peritonitis.
* Vital signs are recorded q1 for 6 hours, then q4 for 24 hours.
54
An endoscopic procedure that involves the use of fiberoptic endoscope.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
54
contraindications in ERCP
1. Ascites
2. Pyloric stenosis
3. Acute infective pancreatitis
4. Severe cardiorespiratory disease
5. Oesophageal obstruction
6. Surgically unfit patient
54
Indications in ERCP
1. Jaundice (undiagnosed caused)
2. Severe or persistent abdominal pain suggesting biliary or pancreatic disease
3. Stones, cysts, or tumor within the duct system which may be missed by other imaging modalities
4. Strictures
5. Complications following biliary surgery (post cholecystectomy)
54
procedure in ERCP
- Patient is slightly sedated and the doctor will insert an endoscope through the mouth, down the esophagus, and into the stomach and small bowel.
- A smaller tube or catheter is passed through the endoscope and into the bile ducts. Dye is injected into the ducts, then take exposure to show whether a tumor is present in bile ducts.
55
equipments needed in ERCP
endoscope
catheter
c-arm machine
56
a piece of medical imaging equipment that operates on the basic principle of X-ray technology.
c-arm machine
57
allows injection of contrast or provides the ability to maintain wire guide access to the desired duct for the introduction of compatible devices. All catheters have three 3mm markings at the distal tip
catheter
58
ong & flexible tube containing a light source, lens system for focusing, and fiber optics to conduct light.
endoscope
59
what projection is used in ERCP?
AP projection
59
patient preparation in ERCP
1. NPO from midnight or at least 6 hours before the procedure.
2. Information about medications, illnesses, allergy, pregnancy so that to provide appropriate instruction to ERCP.
3. Informed consent.
4. May need antibiotics prior to ERCP
5. Local anaesthetic sprayed to throat immediately before intubation.
6. May require sedation.
59
This is a direct examination of the gallbladder done in the operating room for aseptic purposes.
- The biliary tract is exposed, and the surgeon will inject the contrast medium into the common bile duct by either directly or following removal of the gallbladder, through an inlying tube.
IMMEDIATE OR OPERATIVE CHOLANGIOGRAPHY (IOC)
60
indications in IOC
1. Used to investigate patency of bile ducts and status of sphincter of oddi
2. To reveal the presence of calculi that cannot be detected by palpations
3. Tumors or lesions
4. Biliary tract constriction
61
things to bring in the operating room for IOC
* Loaded cassettes (8x10)
* Grid
* Lead apron and thyroid shield
* X-ray machine
62
pre-procedural actions in IOC
* Before entering the OR, change your shoes with OR slipper, wear gown, cap, and mask
* Place the cassette and grid at the cassette holder located under the patient’s table
62
contrast media administration in IOC
* If the gallbladder is removed the surgeon will insert a T-tube into the common bile duct
* Contrast media is injected through the tube
62
how much contrast media is injected in the 1st and 2nd injection?
1st = 10 cc
2nd = another 10 cc (if necessary)
63
what projection is used in IOC examination?
AP projection hehe
63
This is done in the x-ray department to determine any presence of remaining stones in the ducts after operation.
DELAYED OR POST-OPERATIVE T-TUBE CHOLANGIOGRAPHY
64
indications in POST-OPERATIVE T-TUBE CHOLANGIOGRAPHY
1. Suspected leftover calculi
2. Patency of the T-tube
65
patient preparation in POST-OPERATIVE T-TUBE CHOLANGIOGRAPHY
1. Light supper evening prior to examination
2. NPO post midnight
3. No breakfast
4. Proceed to the department on time
66
pre-procedural actions for POST-OPERATIVE T-TUBE CHOLANGIOGRAPHY
* Skin testing of the contrast media is done before the procedure
* Secure informed consent
* Prepare necessary materials such as contrast media, distilled water, wet and dry cotton balls, betadine, and syringe
67
what projection is used for scout film for POST-OPERATIVE T-TUBE CHOLANGIOGRAPHY
AP projection ehe
68
what are the projections for series film for POST-OPERATIVE T-TUBE CHOLANGIOGRAPHY
1. AP projection
2. RAO projection
69
Projections for CHOLE-GIS
1. Gallbladder – AP and RAO or PA and RPO
2. Esophagus – RPO or RAO
3. Stomach – AP, LAO, RAO
4. Spot film of the duodenal bulb – AP
5. 1 hour delayed film – AP or PA
6. Post motor meal – AP or PA
69
This is the combination of the examination of the GB and GI tract.
CHOLE-GIS
RCE
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