Radiography Biliary System (Procedures)

Front 1

What is the largest organ in the body

Back 1

Liver

Front 2

What is the ligament called that holds the liver in place?

Back 2

Falciform ligament

Front 3

Where does the gallbladder sit?

Back 3

On the posteroinferior surface of the liver. It kind of flops all over the place.

Front 4

What organ makes the bile and how much is made per day?

Back 4

The liver. 1-3 pints per day.

Front 5

What is the Ampulla of Vater also called?

Back 5

Hepatopancreatic Ampulla

Front 6

Where is the common bile duct in relation to the gallbladder?

Back 6

It is posterior to the gallbladder

Front 7

How does the patient need to lay in order the drain the gallbladder?

Back 7

On the back.

Front 8

The hepatopancreatic sphincter is also called?

Back 8

The Sphincter of Oddi.

Front 9

When does the sphincter of Oddi open?

Back 9

It stays closed until digestion.

Front 10

Where is the Ampulla of Vater in relation to the Sphincter of Oddi?

Back 10

It comes before the Sphincter of Oddi.

Front 11

What does the gallbladder look like?

Back 11

It is pear-shaped.

Front 12

What are the different parts of the gallbladder?

Back 12

The fundus is the widest part
The Body is the middle
The Neck is the narrowest part

Front 13

3 Functions of the Gallbladder

Back 13

To store bile until needed
Concentrate the bile and remove water from it
Contracts when stimulated to expel bile.

Front 14

How much bile can the gallbladder store?

Back 14

2oz or 30-40cc

Front 15

What hormone stimulates the gallbladder to contract?

Back 15

CCK or cholecystokinin

Front 16

Parts of the pancreas

Back 16

Head
Neck
Tail

Front 17

Is the pancreas part of the biliary system?

Back 17

No, it's part of the exocrine and endocrine systems.

Front 18

The duct in the middle of the pancreas is the called what?

Back 18

The duct of Wirsung
Also called the pancreatic duct.

Front 19

Some people have an additional duct that has no function. What is it called?

Back 19

The Accessory Duct of the Duct of Santorini. It does not open in the ampulla of Vater and is non-functioning.

Front 20

What system is the spleen a part of?

Back 20

The lymphatic system.

Front 21

Do any ducts connect to the spleen?

Back 21

No. It is ductless

Front 22

What is the Cholecystogram done to see?

Back 22

The gallbladder

Front 23

What contrasts are used for the cholecystogram?

Back 23

6 Telepaque tablets.
Neo-Cholex

Front 24

When are the telepaque tablets taken and how many?

Back 24

6 of them are taken 5 minutes apart 10-12 hours before the exam.

Front 25

4 Questions to ask patient before cholecystogram

Back 25

How many pills where taken and at what time?
Did you have a reaction when you took these pills?(Diarrhea)
Did you eat breakfast?
Do you still have your gallbladder?

Front 26

What kVp range should be used when using iodinated contrast?

Back 26

65-75. Should never be higher than 80.

Front 27

What is orographin?

Back 27

Additional contrast to 6 Telepaque tablets if gallbladder didn't show up as well as needed.

Front 28

What is Neo-Cholex?

Back 28

For fatty meal. To Assess function of gallbladder. When taken, gallbladder is supposed to contract and shrink to release bile. This should take 30 minutes after they drink this.

Front 29

What is an Intravenous Cholangiogram?

Back 29

Not done routinely because contrast gets diluted and takes a long time. DONE WITH TOMOGRAPHY!!

Front 30

What contrast is used for Intravenous Cholangiogram?

Back 30

Cholagrafin. It is done to see ducts.

Front 31

What does cholegraphy mean?

Back 31

Radiographic study of biliary system

Front 32

What does cholangiography mean?

Back 32

Radiographic study of biliary ducts

Front 33

What does cholecystangiography mean?

Back 33

Radiographic study of gallbladder and biliary ducts

Front 34

What does choledocholithiasis mean?

Back 34

Stone in common bile duct

Front 35

What does cholecystopaque mean?

Back 35

Contrast medias for gallbladder

Front 36

What does cholecystogogue mean?

Back 36

Fatty meal contrast

Front 37

What does PTC mean?

Back 37

Percutaneous Transhepatic Cholangiogram

Front 38

What supplies are needed for a PTC?

Back 38

CHIBA NEEDLE
-Goes across liver into the ducts. DOESN'T go into liver
OMNIPAQUE 300

Front 39

What is a PTC done for?

Back 39

Used if patient is Jaundice and all other studies have failed to diagnose

Front 40

What is a T-tube Cholangiogram?

Back 40

Surgeons put in a T-tube in the common bile duct and the other part of the tube goes out of the body and drains bile into a bag. This exam is down 1-3 days after the tube is put in place.

Front 41

What contrast is used for a T-tube Cholangiogram?

Back 41

Omnipaque 300

Front 42

What is the most common problem with gallbladders?

Back 42

Stones

Front 43

What are the two types of stones?

Back 43

Calcium and Cholesterol.

Front 44

What percent of stones are calcium?

Back 44

15%. The show up positive and are considered radiopaque.

Front 45

Why do people get calcium stones?

Back 45

From getting too much calcium

Front 46

What percent of stones are cholesterol?

Back 46

85%. The show up negative and are considered radiolucent

Front 47

5 Indications (reasons) for Oral Cholecystogram

Back 47

1.Cholelithiasis
2.Cholecystitis
3.Biliary neoplasia (Unusual growth in gallbladder
4.Opacities or masses (Growth on gallbladder)
5.Biliary stenosis (Narrowing of one of the ducts)`

Front 48

8 Contraindication for OCG

Back 48

1.Vomiting or diarrhea
2.Pyloric obstruction
3.Malabsorption syndrome (intestines don't absorb)
4.Severe jaundice
5.Liver dynsfunction
6.Hepatocellular disease
7.Hypersensitivity to iodinated contrast
8.Cannot give contrast to patient

Front 49

Type of exam where contrast is taken by mouth

Back 49

oral cholecystogram

Front 50

Type of exams where contrast is given intravenously?

Back 50

Intravenous cholangiogram

Front 51

Type of exam where contrast is given directly?

Back 51

PTC
OR Cholangiogram
T-tube
ERCP

Front 52

What films are taken for an OCG?

Back 52

AP Upright
LAO Upright
Rt. Lat. Decub.

Front 53

Why do you do an AP KUB instead of a PA KUB for an OCG?

Back 53

Gallbladder is closer to film in PA, but gallbladder looks foreshortened or smaller than it is is PA.

Front 54

How does the gallbladder move and when do you take the film (expiration or inspiration)?

Back 54

FULL EXPIRATION
It moves 1-3" superiorly and laterally.
FULL INSPIRATION
It moves 1-3" inferiorly and medially

Front 55

When doing an upright for an OCG, what are you looking for?

Back 55

Looking to see if stones settle and to see mobility.

Front 56

In a hypersthenic patient, where is the gallbladder?

Back 56

It is directed anterior and almost horizontal. Will appear circular or triangular.

Front 57

In a sthenic patient, what does the gallbladder look like?

Back 57

It looks like a pear.

Front 58

When looking at at radiograph, how would you tell if the patient had stones?

Back 58

You may see a horizontal line in the gallbladder when doing the uprights.

Front 59

What is the Rt. Lat. Decub. done to see?

Back 59

MOST IMPORTANT PICTURE
Because it shows stratification or laying of stones better than uprights.

Front 60

Where is the T-Tube placed?

Back 60

In the common bile duct

Front 61

What films are taken for a T-tube?

Back 61

AP (RUQ) Scout
RPO (RUQ) Scout
(Inject contrast and then do the following projections)
AP (RUQ)
RPO (RUQ)

Front 62

Before injecting contrast for a T-Tube, what must you do?

Back 62

CLAMP OFF THE BAG!!!
MAKE SURE NO AIR IS INJECTED!!!

Front 63

How do you hold the needle when injecting contrast?

Back 63

Needle is pointed down

Front 64

After exam, what must you do to the bag?

Back 64

UNCLAMP BAG!!!