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Flashcards in Alternative PPT Deck (23):
1

Cholegraphy

Radiographic study of the
Biliary system

2

Cholecystography

Radiographic investigation
of the Gallbladder

3

Choliangography

Biliary ducts

4

***What does PTC stand for?

Percutaneous Transhepatic Cholangiography

5

PTC Procedure:

Right side of patient is prepped with local anesthetic
Chiba needle is inserted through right lateral intercostal space and advanced to liver hilum
Stylet is removed and syringe with contrast is attached to needle
After filling of ducts needle is withdrawn

6

If dilated biliary ducts are identified

A drainage catheter is placed into biliary duct

7

Guidewire is passed through

Needle lumen & needle is removed

8

Catheter is passed over

Guidewire and wire is removed
Left in place for prolonged drainage

9

***PTC Procedure is used for

• Preoperative radiologic examination
• Jaundice patients with positive CT or sonogram
for dilated ductal system
– Cause is unclear
• Utilizes a _CHIBA_____ or “skinny” needle
• Procedure also is used to place drainage
catheter for treatment of obstructive jaundice

10

Postoperative (T-Tube) Cholangiography also known as

Postoperative,
Delayed or T-tube choliangiography

11

***Explain the postoperative t-tube cholangiograpm:

Exams the biliary tract using a T-shaped or pigtail shaped catheter
Follows a cholecystectomy
Left in common hepatic & common bile ducts for postoperative drainage

12

What type of procedure is used to place a T-tube and pigtail catheter?

T-tube is placed during a surgical procedure
Pigtail catheter is placed during a laparoscopic biliary procedure

13

***What is the purpose of the postoperative T-tube cholangiogram?

Demonstrates caliber & patency
Status of sphincter of hepatopancreatic ampulla
Presence of stones or other pathologic conditions such as strictures

14

Why is the drainage tube clamped the day before the procedure?

Allows tube to fill with bile to prevent air bubbles within the duct from mimicking stones (preventive measure)

15

Water-soluble iodinate contrast
– Density of no more than

5% to 30%
• Obscured small stones

16

How to position pt for Postoperative Cholangiogram Procedure

Place patient in an _RPO______
– RUQ is centered to midline of grid
– Projects biliary ducts away from spine

17

Images are taken during fractional injections and
specified intervals until contrast has entered

Duodenum

18

Lateral projection of Postoperative Cholangiogram to demonstrate

Anatomic branching of hepatic ducts & to detect any abnormality

19

***Clamp is generally not removed from

Tube before procedure is complete
– Drainage of excess bile @ beginning of study

20

***ERCP Stand for

Endoscopic Retrograde Cholangiopancreatography

21

***What is the purpose for an ERCP?

It is used to diagnose biliary and pancreatic pathology
Therapeutic procedure: Removal of choleliths or small lesions & Repair a stenosis of a duct

22

ERCP Procedure:

Endoscope is placed through mouth into duodenum
A small cannula is passed into the hepatopancreatic ampulla
Contrast is then injected into common bile duct (retrograde injection)
Contrast drains from ducts within 5 minutes of injection

23

ERCP is useful when biliary ducts are NOT

Dilated and no obstruction exist @ ampulla