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67 Cards in this Set
- Front
- Back
What are the 3 major non-vascular interventions performed by radiologist
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biliary
GU abscess drainage |
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What is a very variable and important draining biliary duct
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righ posterior biliary duct
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What does the variant anatomy of the right posterior draining duct look like when it comes off the left main biliary duct
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What does the variant anatomy of the right posterior duct look like when it is draining directly from the main hepatic duct
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When is identification of this duct crucial
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during laparoscopic cholecystectomy because misidentification can lead to accidental transection
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What are 2 types of invasive biliary imaging
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ercp
ptc (percutaneous transhepatic cholangiogram) |
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How is PTC performed
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a 22 g needle is advanced into the liver parenchyma under fluoroscopic guidance
Slowly withdraw and inject contrast until ducts are opacified |
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When do you stop injecting contrast
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once u see all the intrahepatic bile ducts (may require multiple passes)
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What 2 things are you most commonly looking for with PTC
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bile duct obstruction and bile duct leak
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What are the common causes of distal CBD obstruction
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ampullary Ca
Pancreatic CA Cholangio CA |
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What are the causes of hilar obstruction
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gallbladder CA
metastatic HCC |
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Do cholangio ca occur anywhere along the course of the bile duct
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yes
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Where does ampullary carcinoma commonly occur
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by the ampulla of vater
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What do malignant and benign cut offs look like
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What are the common surgical causes of benign biliary disease
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biliary surgery
bile duct injury liver transplant |
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What are infectious causes of benign biliary diseae
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sclerosing cholangitis
pancreatitis |
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What are 2 stone related disease that cause biliary disease
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mirizzi
recurrent pyogenic cholangitis |
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What are 3 indications for percutaneous transhepatic biliary drainage
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palliation
biliary stricture or leak access for stone retrieval |
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What is the pallative reason for PTBD
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pruritis, cholangitis
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What are the contraindications to PTBD
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unfavorable anatomy
coagulopathy thrombocytopenia |
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What colonic interposition
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this is when the colon is ventral to the liver and unfavorable anatomy for PTBD
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Is ascites and liver cyst unfavorable anatomy for PTBD
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yes
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How is PTBD performed
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first PTC is done then a catheter is inserted. The tract is dilated and a larger catheter is put in
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What is the 2 MC complications of biliary drainage
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biliary sepsis
arterial injury |
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What is the indication for metal stents in bile ducts
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palliation of malignant disease
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What is a major problem with metal stents
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they do not stay open for a long period of time (6 months)
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What type of metal stent is MC for the bile system
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the wallstent
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What is the preferred treatment of a biliary stricture
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balloon dilation and if that fails surgical revision
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What is the reason for percutaneous cholecystostomy
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acute cholecystitis
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Why would a IR doc do a percutaneous cholecystomy instead of a cholecytectomy for acute cholecystitis
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acalculous cholecystitis
calculous cholecystitis |
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How is percutaneous cholecystomy done
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need is placed into the gallbladder then the tract is dilated and a drain is placed
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What is the clinical success of PC for cholecystitis
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50-90%
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What are the complications of PC
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hemorrhage
bile peritonitis |
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When should the tube be removed
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6 weeks. Once a fibrous tract is formed
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What should be done prior to removing the tube
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do a cholecystogram and look for stones or strictures of the cystic duct
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What are the indications of a nephrostomy tube
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urinary obstruction or leak
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Can a large renal cyst be a contraindication to a nephrostomy tube
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yes
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Where is the appropiate location to place a nephrostomy
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What is the site of insertion of a nephrostomy tube
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4 fingers widths away from midline below the 12th rib posteriorly
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What are you aiming for in the kidney
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a posterior calyx
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What do you want to be sure to avoid when placing a nephrostomy tube
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the renal pelvis where the large vessels are located
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What is used to guide a nephrostomy tube
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US
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What is the size of a nephrostomy tube
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8-12 f
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What are the complications of nephrostomy tube placement
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urosepsis and bleeding
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What are the indications for ureteral stents
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obstruction and leak
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Describe a urinary stent
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a tube from the renal pelvis to the urinary bladder
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What does a double J and multiloop stent look like
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What is the tx of a urine leak following a transplant
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double J stent
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What are the contraindications for a percutaneous abscess drainage
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inaccessible
non-drainable coagulopathy |
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Is a hematoma drainable
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no
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What is the technique for PAD
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antibiotics
shortest route not thru bowel |
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Can you go thru stomach, rectum, vagina or transpleural
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yes, may be OK
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Can a drainage be performed thru the liver
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yes, not ideal but it can be done
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Where is the appropiate site for transgluteal drainage
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Where do you want to go for transgluteal approach
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as medial and low on the sacrum as possible to avoid injury to the sciatic nerve
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What must one be aware of when doing a transgluteal approach for PAD
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not to injury the sciatic nerve or vessel
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Why do IR doctors not like to drain splenic abscess
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the spleen is vascular and this increases the risk of bleeding
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Do splenic abscesses respond to antibiotics
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usually they do, but if not then drainage may be attempted
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When is the only time we drain pseudocyst
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when they are symptomatic
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What is the MC cause of a symptomatic pseudocyst
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infection
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What is problem with draining a pancreatic abscess
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they tend to be viscous and multiple tube changes and prolonged drainage is often required
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What are the causes of liver abscess
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biliary
portal vein source contigous spread hepatic sourse |
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What is the MC cause of a liver abscess
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biliary (35%)
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What are the 3 MC organisms that cause liver abscesses
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bacterial
amebic ecchinococcal |
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If a live abscess has multiple septations and a fair amount of necrotic debri will it respond well to drainage
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probably not
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Do infected liver mets heal
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no, there is no normal healing process
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What is the treatment for infected liver metastasis
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a drainage tube that will stay in place for life
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