Biliary And Urinary

Question 0

List 3 primary functions of the GB

Answer 0

Stores bile
Concentrates bile
Contracts to release bile when stimulated by CCK

Question 1

Name the shape and the 3 parts of the GB

Answer 1

Pear shaped

Neck body and fundus

Question 2

List the passage of bile from the small lobes of the liver to the release into the duodenum

Answer 2

L&R hepatic duct➡️common hepatic duct ➡️cyclic duct➡️GB➡️cystic duct➡️️common bile duct➡️junction of the main pancreatic duct➡️ampulla of vater➡️sphincter of oddi➡️terminal opening➡️duodenum

Question 3

List all exams with the biliary system that spot fluoro or digital radiographs are the only basic images taken

Answer 3

PTC
ERCP
T TUBE or Post op or Delayed Cholangiogram
Surgery exams

Question 4

Which biliary system exam may warrant a chest x ray immediately following the procedure an why

Answer 4

PTC

Needle may hit lung (pneumothorax)

Question 5

List basic projections taken for an Operative Cholangiogram and where is the CR

Answer 5

AP scout
AP post injection
*LPO AND RPO optional

CR enters where the surgeon indicates over biliary ducts

Question 6

Who is all involved with an Operative Cholangiogram

Answer 6

Surgeon: indicates centering, coordinates filming and injects contrast media (6-8 ml)
Anesthesiologist: stops pt breathing during x ray exposure
RT: takes x ray exposure to include an image of the biliary ducts full of contrast

Question 7

Explain an ERCP

Answer 7

•Usually performed after an US
•A GI dr passes a fiber-optic endoscope (a duodenoscope) from mouth through esophagus and stomach into the duodenum. Then a catheter or small cannula is endeared through the scope into the opening o the sphincter of oddi into the duct of choice (biliary or pancreas) all performed under fluoro
•can be diagnostic or therapeutic
*can relieve pathological conditions such as choleliths or small lesions or repair a stenosis of the HP sphincter or ducts
* contrast can be injected via retrograde into ducts to open strictures and look for pathologies
•RT’s role is to set the room up for fluoro, assemble tray, draw up contrast, ask pt hx, take scout image and assist the GI dr with fluoro
•radiologists takes fluoro images

Question 8

List 4 reasons a scout image is taken for any exam

Answer 8

1. To determine correct positioning, tech factors, and centering
2. To make sure pt is prepped properly
3. To show to radiologist who looks for abnormalities and contraindications
4. To localize anatomy of interest

Question 9

List all advantages of Ultra sound vs OCG

Answer 9

No ionizing radiation
Detects smaller calculi than OCG
Exam take less time
Quicker results or diagnosis
Noninvasive; no contrast involved

Question 10

List advantages of Laparoscopy Cholangiogram vs Operative Cholangiogram

Answer 10

Less Hospital time less cost
Less scarring
Less recovery time
Less trauma to pt bc less invasive

Question 11

What is the largest solid organ in the human body

Answer 11

Liver

Question 12

What is the livers primary function

Answer 12

Produce bile

Question 13

What pt position puts GB closest to the film

Answer 13

Prone

Question 14

Describe GB position with pts body habitus

Answer 14

Hyperstenic (broad pt) GB higher an more lateral in right hypochondriac region
Sthenic/hyposthenic (average slightly skinny) GB 1/2 between xiphoid and lower rib margin
Asthenic (very skinny) GB low and medial next to vertebral column and near pelvis

Question 15

List 2 laparoscopic studies performed with biliary system and give brief description

Answer 15

Laparoscopic cholecystectomy = surgical removal of the GB

Laparoscopic Cholangiography= surgical study of the biliary ducts

Question 16

For an IV Urogram list the obliques, tell why and tell what is seen the best with each Obl

Answer 16

30° LPO - left ureter and right kidney
30° RPO - right ureter and left kidney

Obl are done bc kidneys sit in a 30° oblique in the body; the 30° Obl position helps rotate the kidney to become parallel to IR

Question 17

List the 3 constricted points in a ureter

Answer 17

Brim of pelvis ( iliac blood vessels cross over ureter)
Ureterovesical junction ( ureter joins under bladder)
Ureteopelvic junction (where renal pelvis and ureter joins)

Question 18

List the 3 common functions of the kidneys

Answer 18

Produce urine
Remove nitrogenous waste
Regulate acid-base balance and electrolyte levels

Question 19

How are the kidneys shaped and how do they sit in the body

Answer 19

Bean shaped
Sit at a 20-30° Obl with MSP
Upper pole sits at a 20°< and lies closer to the midline
Medial boarder is more anterior than lateral boarder

Question 20

List the renal artery system

Answer 20

Abdominal aorta, R&L renal arteries and capillaries

Question 21

Why is the basic functional unit of the kidney

Answer 21

Nephron

Question 22

List all words that mean void

Answer 22

Micturation
Urination
Excretion

Question 23

What does incontinence mean

Answer 23

The inability to control the urge to void

Question 24

Tell the difference between the male and female urethra

Answer 24

The male urethra is longer and larger in diameter and is used or passage of urine and semen

Question 25

List pt prep for an excretory urography

Answer 25

Liquid evening meal night before Enema or latitude taken day before exam NPO 8hrs Empty bladder just prior to exam

Question 26

List the basic images taken for an excretory urography

Answer 26

AP scout KUB 1min nephrogram or nephrotimography or tomosynthesis AP KUB at 5 min, 15 min 20 min 30° LPO and RPO (Any other radiologist requests) Post void image KUB or bladder shot either AP or PA

Question 27

List the centering point for posterior Obl for an IVU with a 10 x 12 and a 14 x 17 image

Answer 27

10x12 vertebral column (abt an 1" from MSP) and 1/2 between xiphoid tip and lower rib margin 14x17 vertebral column (abt 1" from MSP) and iliac crest

Question 28

List the basic images for a retrograde urography

Answer 28

``` Scout AP KUB abd: after catheterization AP Pyelogram KUB: after urologist injects 3-5 mL of contrast directly thru catheter into renal pelvis of 1 or both kidneys AP Ureterogram (KUB): when urologist indicates after he withdraws catherter and simultaneously injects contrast into one or both ureters ```

Question 29

List the CR angles for a cystography study

Answer 29

AP < 10-15° caudad, enter 2" above pubic symphysis 45-60° LPO & RPO : CR perpendicular and 2" above pubic symphysis and 2" medial to ASIS Lateral: CR Perpendicular and 2" above pubic symphysis and posterior to ASIS

Question 30

List the images for a voiding cystourethrography

Question 31

Where is the adipose capsule and what is its importance

Answer 31

It surrounds the kidneys and protects them. It allows the kidney shadows to be seen on a KUB

Question 32

Where do the kidneys lie in the abd cavity

Answer 32

In the retroperitoneal space - upper posterior abd 1 on each side of vert column 1/2 between xiphoid and iliac crest Upper pole - more posterior and closer to midline Lower pole- more anteriorly

Question 33

What is the trigone

Answer 33

Triangular portion along inner posterior surface of bladder where the ureters enter and the urethra exits

Question 34

What is the importance of B.U.N. And creatinine lab results for an IVU and what are normal ranges for both

Answer 34

Diagnostic indicators of kidney function. To make sure kidneys can filter out contrast. B.U.N. = 8-25mg/100 mL Creatinine = 0.6-1.2 mg/dL ( in adult males ) and 0.5-1.1 mg/dL (in adult females) basically .5-1.5 textbook

Question 35

What position would be helpful if pt cannot have Ureteric compression for an IVU to achieve similar results?

Answer 35

15° trendelenburg

Question 36

How is contrast administered for a Urogram and a cystogram

Answer 36

Urogram : IV or catheter | Cystogram : catheter

Question 37

What urography study is performed on on males? Explain procedure and projection

Answer 37

Retrograde urethrography A Brodney clamp is attached to the distal penis. Contrast media is injected retrograde into the distal urethra until the entire urethra is filled to demonstrate its full length. 30° RPO perpendicular to symphisis pubis 10x11 longwise

Question 38

Why is it important to determine if a pt is taking metaformin or a drug with a component of metaformin

Answer 38

Possible development of metaformin associated lactic acidosis in susceptible pt, therefore guidelines suggest metaformin be discontinued at time of procedure and withheld for 48 hrs after