Transcript Biliary System

Prefinal topic
Prepared by: Aries Paul P. Zeta, RRT
is
pear-shaped sac,
composed of three-parts –
fundus, body and neck.
7 – 10 cm long, 3 cm wide and
normally holds 30 to 40cc’s of
bile.
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.
Right
& Left hepatic
ducts
Common hepatic duct
Cystic duct
 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
 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.
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 ( postoperative, delayed, or T-tube)
Each
method of
examination is named
according to;
• The route of entry of the
medium
• The portion of the biliary tract
examined
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.
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.
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.
 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.
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 3hrs after evening meal.
 Nothing by mouth.
 Breakfast is usually withheld in all methods.

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.
Supine
Prone
Prone oblique
Upright
Lateral decubitus
 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.
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.
Laxative
Restricted
diet
Enemas
Breakfast
is withheld
10
min. – timed from the
completion of the injection
until satisfactory
visualization.
30 – 40 min. maximum
pacification.
Not
indicated for
patients who have liver
disease or for those
whose biliary ducts are
not intact.
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.
 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
 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.
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.
 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.
Obstructive
jaundice
Cholangiocarcinoma
Stones in the biliary passages
Strictures of common bile
ducts
Choledochal cysts
Radiologic
terms applied
to the biliary tract
examination that is
determined by way of the T
– shaped tube left in CBD
for postoperative drainage.
 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
 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.
 Is
one of the water-soluble, organic
contrast media.
 25 – 30% density of contrast medium is
used.
 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
 non-consent
by patient to procedure
 contrast or iodine allergy
 pregnancy (? pregnancy test required)
 barium study within last 3 days
 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.
 The
patient is positioned supine on the xray 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.
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.
 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
 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.
1.
2.
3.
Investigate the patency of the
biliary/pancreatic ducts.
Reveal any choleliths not previously
detected.
Demonstrate small lesions, strictures or
dilatations within the biliary/pancreatic
ducts.