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Special Imaging > Quiz 5 > Flashcards

Quiz 5 Flashcards

1
Q

What does an ERCP examine?

A

the biliary tree and the pancreatic duct system

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2
Q

What are the main ducts composing of the biliary tree?

A
  • Right and Left hepatic ducts
  • Common Hepatic duct
  • Cystic duct
  • Common Bile duct
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3
Q

If there is a tumor located in the pancreas, where is the best location due to ease of fixing it?

A

In the c-loop of the duodenum ( the tail end is harder to reach)

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4
Q

What is the endocrine function?

A

producing the hormones insulin and glucagon

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5
Q

What is the exocrine function?

A

producing digestive enzymes

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6
Q

What are indications for an ERCP?

A

Diagnostic
- Stenosis, dilation, obstruction or small lesions within the biliary or pancreatic duct
- Preoperative or postoperative procedure
- inconclusive gallbladder studies

Therapeutic
- Sphincterotomy may be performed to repair a stenosis of the sphincter of oddi or to facilitate stone removal from the bile ducts
- Stones can be removed either y threading a balloon catheter beyond the stone, inflating the balloon and then with drawing the balloon and stones into the duodenum or by using a basket catheter to retrieve the stone
- Biliary duct stenoses can be treated by dilation with a balloon catheter, by stent placement or by balloon dilation along with stent placement
- Pancreatic stones can also be removed by using either a balloon catheter or a stone basket for retrieval

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7
Q

What equipment is needed for an ERCP?

A

Imaging Equipment
- Fluoroscopic unit with a spot radiograph device
- Tilting table

Procedural Equipment ( Nurse normally brings)
- Patient monitoring device
- video equipment
- duodenoscope
- cannulae
- suction equipment
- medications, drugs and contrast agents (depends on place if you bring contrast or if they have it)
- injection materials
-

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8
Q

What is a duodenoscope?

A

an endoscope with a wide angle lens and side view capability, has a channel through its length through which a variety of cannulae or catheters may be advanced for diagnostic or therapeutic purposes; radiopaque tip

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9
Q

What are contraindications for an ERCP?

A
  • Pancreatic pseudocysts
  • Acute pancreatitis
  • Septic cholangitis
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10
Q

How long does a patient need to be NPO for for an ERCP?

A

At least 4 hours

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11
Q

What is included in the preprocedural care for an ERCP?

A

1- Informed consent signed- procedure and related risks explained to the patient
2- Allergy history is reviewed- drugs and contrast agents for procedure are reviewed
3- Previous contrast reactions- patient should be premedicated according to protocol
4- NPO for at lease 4 hours before the procedure
5- Intravenous line inserted with normal saline or 5% detrose in water

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12
Q

What medications are needed for an ERCP?

A
  • Xylocaine: topical anesthetic
  • General anesthetic - for children and for patients unable to cooperate
  • Injectable drugs - administered directly into the intravenous lines
  • Sedatives - demeral, valium versed
  • Versed - hypnotic effect, causing retrograde amnesia for a period of several hours post injection
  • Oxygen
  • Antispasmodic drugs - such as glucagon, this is given to relieve spasm of the duodenum and sphincter of oddi from the presence of the endoscope and cannula
  • Narcan or mazicon - drugs that reverse the effectived of the sedatives
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13
Q

Who is the ERCP team?

A

1- Gastroenterologist - Endoscopist
2- Two nurses
3- Radiologist
4- Radiographer

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14
Q

During an ERCP, where is the patients head placed?

A

toward the foot end of the table

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15
Q

What position is the patient started in for an ERCP?

A

In a steep LAO until the patients throat is sprayed with anesthetic and medication is administered by the nurse and endoscopic tubing is passed through to the patients duodenum

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16
Q

Once the patient is in position within the duodenum, how is the patients position changed?

A

They are rolled down into a slight LAO or prone position

17
Q

After the patients position is changed, what happens next?

A

The scope is manipulated until the papilla of vater is visualized face up

18
Q

After the scope is manipulated until the papilla of the vater is visualized face up, what happens next?

A

The cannula is then threaded through the endoscope and inserted through the papilla opening and advanced into the appropriate duct system

19
Q

Once the cannula is advanced into the appropriate duct system, what happens next?

A

Fractional injections of the contrast agent, under fluoroscopic control, guide and verify proper cannula placement

20
Q

After verifying proper cannula placement, what happens next?

A

The contrast agent is injected and the appropriate spot films are taken

21
Q

What kind of contrast media is used in an ERCP?

A

Water Based Iodinated contrast agents
1- Renographin M60 - Ionic
2- Isovue 300 - Nonionic

22
Q

What is postprocedural care for an ERCP?

A

1- Recovery room- 1/2 hour for inpatients; 1 hour for outpatients
2- No food/fluids - sensation to the throat has returned
3- Vital signs monitored

23
Q

What are complications of an ERCP?

A

1- Pancreatitis- very low incidence; less than 2%
2- Postprocedural infection caused by the rupture of pancreatic pseudocysts
3- Postprocedural cholangitis and septicemia caused by biliary obstruction
4- Reactions to drug administration
5- Perforation of the digestive tract by endoscopic equipment

24
Q

What is the most common complication of an ERCP?

A

Perforation of the digestive tract by endoscopic equipment

25
Q

What are the common images taken for an ERCP?

A

Preprocedural AP abdomen & Post contrast AP abdomen

26
Q

What does an operative or immediate cholangiogram demonstrate?

A

The anatomy of the biliary ductal systems, drainage into the duodenum and any residual stones in the biliary ducts

27
Q

When is an operative or immediate cholangiogram performed?

A

Before or following surgical removal of the gallbladder

28
Q

What happens in an operative or immediate cholangiogram?

A

The surgeon places a small catheter into the biliary ducts and injects 6 to 8 ml of contrast media in to the ducts

29
Q

What is a laparoscopic cholecystectomy?

A

Provides a less invasive approach for the removal of diseased gallbladder; and the visual assessment of the abdomen to detect signs of pathology or trauma

30
Q

What happens during a laparoscopic cholecystectomy?

A

The surgeon makes a small opening in the umbilicus and passes an endoscope into the abdominal cavity

31
Q

What are the advantages of a laparoscopy?

A

It can be performed as an outpatient procedure; minimally invasive procedure; requires reduced hospital time over other procedures with reduced cost

32
Q

What images are obtained for Operative or laparoscopic cholangiogram?

A

At least two preferably three radiographic images obtained in slightly different positions; Each exposure is preceded by a fractional injection of contrast media; RPO if helpful in projecting the biliary ducts away from the spine, especially with hyposthenic patients

33
Q

What anatomy is demonstrated in a operative or laparoscopic cholangiogram

A

Common bile duct, hepatic duct, and cystic duct

34
Q

What are clinical indications for a Postoperative (T-tube or Delayed) Cholangiography?

A
  • Residua calculi- undetected stones may remain in the biliary ducts after the operative cholangiogram. The T-tube cholangiogram enables the radiologist to determine the location of stones and remove them, if possible, through a specialized catheter\
  • Strictures- a region of the biliary ducts may have been narrowed during the operative cholangiogram and may need further investigation
35
Q

What are contraindications of a postoperative (t-tube or delayed) cholangiogram?

A
  • Hypersensitivity to iodinated contrast media
  • Acute infection of the biliary system
  • Elevated creatinine or blood urea nitrogen (BUN) levels
36
Q

What is included in patient preparation for postoperative (t-tube or delayed) cholangiogram?

A

Varies according to department protocol
- Procedure needs to be clearly explained to the patient
- Clinical history needs to be taken
- Patient should be in a hospital gown and NPO for at least 8 hours before the procedure

37
Q

What equipment is needed for a postoperative (t-tube or delayed) cholangiogram?

A
  • R & F Room
  • Radiographic images will be taken after the fluoroscopic procedures
  • Syringes of various sizes
  • Syringe adapters
  • Emesis basins
  • Gloves
  • Sterile drapes
38
Q

What kind of contrast media is used for a postoperative (t-tube or delayed) cholangiogram?

A
  • Iodinated water soluble contrast medium; it may be diluted concentration to prevent obscuring a small calculi (stone)

Special Imaging (7 decks)

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