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67 Cards in this Set

  • Front
  • Back
What are the 3 major non-vascular interventions performed by radiologist
biliary
GU
abscess drainage
What is a very variable and important draining biliary duct
righ posterior biliary duct
What does the variant anatomy of the right posterior draining duct look like when it comes off the left main biliary duct
What does the variant anatomy of the right posterior duct look like when it is draining directly from the main hepatic duct
When is identification of this duct crucial
during laparoscopic cholecystectomy because misidentification can lead to accidental transection
What are 2 types of invasive biliary imaging
ercp
ptc (percutaneous transhepatic cholangiogram)
How is PTC performed
a 22 g needle is advanced into the liver parenchyma under fluoroscopic guidance

Slowly withdraw and inject contrast until ducts are opacified
When do you stop injecting contrast
once u see all the intrahepatic bile ducts (may require multiple passes)
What 2 things are you most commonly looking for with PTC
bile duct obstruction and bile duct leak
What are the common causes of distal CBD obstruction
ampullary Ca
Pancreatic CA
Cholangio CA
What are the causes of hilar obstruction
gallbladder CA
metastatic
HCC
Do cholangio ca occur anywhere along the course of the bile duct
yes
Where does ampullary carcinoma commonly occur
by the ampulla of vater
What do malignant and benign cut offs look like
What are the common surgical causes of benign biliary disease
biliary surgery
bile duct injury
liver transplant
What are infectious causes of benign biliary diseae
sclerosing cholangitis
pancreatitis
What are 2 stone related disease that cause biliary disease
mirizzi
recurrent pyogenic cholangitis
What are 3 indications for percutaneous transhepatic biliary drainage
palliation
biliary stricture or leak
access for stone retrieval
What is the pallative reason for PTBD
pruritis, cholangitis
What are the contraindications to PTBD
unfavorable anatomy
coagulopathy
thrombocytopenia
What colonic interposition
this is when the colon is ventral to the liver and unfavorable anatomy for PTBD
Is ascites and liver cyst unfavorable anatomy for PTBD
yes
How is PTBD performed
first PTC is done then a catheter is inserted. The tract is dilated and a larger catheter is put in
What is the 2 MC complications of biliary drainage
biliary sepsis
arterial injury
What is the indication for metal stents in bile ducts
palliation of malignant disease
What is a major problem with metal stents
they do not stay open for a long period of time (6 months)
What type of metal stent is MC for the bile system
the wallstent
What is the preferred treatment of a biliary stricture
balloon dilation and if that fails surgical revision
What is the reason for percutaneous cholecystostomy
acute cholecystitis
Why would a IR doc do a percutaneous cholecystomy instead of a cholecytectomy for acute cholecystitis
acalculous cholecystitis
calculous cholecystitis
How is percutaneous cholecystomy done
need is placed into the gallbladder then the tract is dilated and a drain is placed
What is the clinical success of PC for cholecystitis
50-90%
What are the complications of PC
hemorrhage
bile peritonitis
When should the tube be removed
6 weeks. Once a fibrous tract is formed
What should be done prior to removing the tube
do a cholecystogram and look for stones or strictures of the cystic duct
What are the indications of a nephrostomy tube
urinary obstruction or leak
Can a large renal cyst be a contraindication to a nephrostomy tube
yes
Where is the appropiate location to place a nephrostomy
What is the site of insertion of a nephrostomy tube
4 fingers widths away from midline below the 12th rib posteriorly
What are you aiming for in the kidney
a posterior calyx
What do you want to be sure to avoid when placing a nephrostomy tube
the renal pelvis where the large vessels are located
What is used to guide a nephrostomy tube
US
What is the size of a nephrostomy tube
8-12 f
What are the complications of nephrostomy tube placement
urosepsis and bleeding
What are the indications for ureteral stents
obstruction and leak
Describe a urinary stent
a tube from the renal pelvis to the urinary bladder
What does a double J and multiloop stent look like
What is the tx of a urine leak following a transplant
double J stent
What are the contraindications for a percutaneous abscess drainage
inaccessible
non-drainable
coagulopathy
Is a hematoma drainable
no
What is the technique for PAD
antibiotics
shortest route not thru bowel
Can you go thru stomach, rectum, vagina or transpleural
yes, may be OK
Can a drainage be performed thru the liver
yes, not ideal but it can be done
Where is the appropiate site for transgluteal drainage
Where do you want to go for transgluteal approach
as medial and low on the sacrum as possible to avoid injury to the sciatic nerve
What must one be aware of when doing a transgluteal approach for PAD
not to injury the sciatic nerve or vessel
Why do IR doctors not like to drain splenic abscess
the spleen is vascular and this increases the risk of bleeding
Do splenic abscesses respond to antibiotics
usually they do, but if not then drainage may be attempted
When is the only time we drain pseudocyst
when they are symptomatic
What is the MC cause of a symptomatic pseudocyst
infection
What is problem with draining a pancreatic abscess
they tend to be viscous and multiple tube changes and prolonged drainage is often required
What are the causes of liver abscess
biliary
portal vein source
contigous spread
hepatic sourse
What is the MC cause of a liver abscess
biliary (35%)
What are the 3 MC organisms that cause liver abscesses
bacterial
amebic
ecchinococcal
If a live abscess has multiple septations and a fair amount of necrotic debri will it respond well to drainage
probably not
Do infected liver mets heal
no, there is no normal healing process
What is the treatment for infected liver metastasis
a drainage tube that will stay in place for life