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29 Cards in this Set

  • Front
  • Back
Choleography
The general term for a radiographic study of the biliary ststem.
Cholecystography
The radiographic investigation of the gallbladder
Cholangiography
The radiographic study of the biliary ducts.
Cholecystangiography
Radiography of the gallbladder and the biliary ducts.
Cholecystcholangiography
Radiography of the gallbladder and the biliary ducts.
List the three routes of contrast administration for the biliary system.
a) By mouth – oral
b) By injection into a vein – intravenous
c) By direct injection into the ducts – percutaneous transhepatic cholangiography (PTC)
Explain why biliary tract examinations are performed.
a) Function of the liver – its ability to remove the contrast medium from the bloodstream and excrete it with the bile.
b) Patency and condition of the biliary ducts.
c) Concentrating and emptying power of the gallbladder.
List some of the key technical requirements for doing biliary tract examinations.
• Short exposure time
• Maximumum soft tissue differentiation (70-80 kVp)
• Small focal spot
• Close collimation
• Exposure at end of expiration
List the common indications for oral cholecystography (OCG).
a) Symptoms related to gallbladder disease
b) Contrast generally well tolerated.
List the common indications for oral cholecystography (OCG).
a) Symptoms related to gallbladder disease
b) Contrast generally well tolerated.
List three factors that contribute to the success of OCG
a) Patient preparation
b) A clear image of the RUQ
c) Preliminary diet
Describe the patient preparation for an OCG
Secure full cooperation with explaination
Give instructructions covering preliminary prep of the intestinal tract, preliminary diet, time to ingest the oral medium, avoidance of laxatives 24 hrs before the exam, avoidance of all food, time to report for exam.
Ask how steps were followed
Ask about any reactions

Laxative administered 24 hrs previous for heavy bowel content
Fat free evening meal
NPO until completion of exam
Contrast given 2-3 hrs after evening meal
Describe the contrast administration for an OCG
Given 2-3 hrs after the evening meal on the night before the exam. 3 g administered as 4-6 tablets.
Explain the importance of a scout radiograph
• To ensure that the contrast material was absorbed and concentrated in the gallbladder.
• Gallbladder visualized
• Technique sufficient
. List the steps that should be observed before an OCG is performed.
• Ensure the patient has not had a cholecystectomy
• Determine the patient followed each step
• Ask about reactions – vomiting w/in 2 hrs after administration
• Determined whether the patient has remained NPO
• Discuss the procedure with the patient
• Have patient change into gown
. Explain the role of a fatty meal and the injection of cholecystokinin as a part of a gallbladder exam.
The fat causes the gallbladder to contract, which will be more visible when the OCG is performed.
CCK also causes muscular contraction of the gallbladder.
Describe the position of the gallbladder in the various body habitus.
More lateral, superior and round as habitus increases
List the advantages of doing an erect gallbladder position.
The degree of angulation and foreshortening are less influenced by body habitus.
Explain the importance of doing a right lateral position.
To differentiate gallstones from renal stones or calcified calcified or eccentric lymph nodes.
To show the gallbladder free from selfsuperimposition or foreshortening from adjacent structures.
Explain the importance of doing a right lateral decubitus position.
• To demonstrate stones that are heavier/lighter than bile
• Permits the gallbaldder to gravitate toward the dependent right side, where it will lbelow any adjacent gas loops and bony superimposition
Intravenous cholangiography (IVC)
Study of the biliary ducts
Cholecystectomy
Surgical removal of the gallbladder
Explain how and why an IVC would be done and include the time frame for visualizing the ducts.
• To investigate the biliary ducts of cholecystectomized patients.
• Maximum opacification within 30-40 minutes.
Percutaneous Transhepatic Cholangiography (PTC)
Preop radiologic exam of the biliary tract.
Explain how and why a PTC is done.
• Used for patients with jaundice when the ductal system has been shown to be dilated by CT or ultrasonography but the cause of the obstruction is unclear.
• Patient supine. Local anesthesia. Chiba needle inserted parallel to floor inserted through right intercostal space toward the liver hilum. Needle withdrawn until contrast seen in the biliary ducts.
Postoperative Cholangiography, t-tube
Performed by way of the T-shaped tube left in the common bile ductfor postop drainage.
Deomonstrates:
• The caliber and patency of the ducts.
• The status of the sphincter of the hepatopancreatic ampulla.
• The presence of residual or preveiously undectected stones.
Endoscopic Retrograde Cholangiopancreatography (ERCP)
A procedure used to diagnose biliary and pancreatic pathologic conditions. Useful when the biliary ducts are not dilated and unobstructed.
Describe how an ERCP is performed.
By passing a fiberoptic endoscope through the mouth into the duodenum under fluoroscopic control. A cannula is passed through the endoscope and directed into the ampulla. Once placed, contrast is injected into the common bile duct.
Explain when an ERCP would be indicated.
When both clinical and radiographic findings indicate abnormalities in the biliary system or pancreas.