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87 Cards in this Set
- Front
- Back
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what is the physiologic function of the liver? |
formation of bile |
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what does bile do? |
aids in the emulsification of fats |
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where is bile carried to and where is it stored? |
carried to the duodenum or stored in the gallbladder |
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what is the largest gland in the body and where is it located? |
liver; located in all of the Rt. hypochondrium and a large portion of epigastruim |
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where is the base of the liver located? |
on the right side of the body |
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where is the apex located? |
projects anteriorly and to the left (epigastrium) |
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what are the lobes of the liver? |
right lobe and left lobe |
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what are the right and left lobes of the liver separated by? |
falciform ligament |
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the liver secretes bile to the gallbladder for temporary storage via |
Rt. and Lt. hepatic ducts |
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the Rt. and Lt. Hepatic ducts merge to form the |
Common Hepatic duct |
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the Common Hepatic duct unites with the ___ @ the |
Cystic duct; gallladder |
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the Cystic duct and Common Hepatic duct merge forming the |
Common bile duct |
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the Common bile duct passes inferiorly 3" merging with the _____ forming the ____ |
Pancreatic duct; Hepatopancreatic ampulla |
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controls flow of bile into descending duodenum |
Sphincter of Oddi |
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what are the three functions of the Gallbladder? |
1. concentration of bile 2. stores bile 3. evacuates bile during digestion |
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hormone secreted by duodenal mucosa that activates gallbladder contraction |
cholecystokinin |
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the gallbladder is located @ the level of the ___ on Rt. or Lt.? |
9th rib |
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the gallbladder is located midway between ___ and _____ |
xiphoid; Rt. lower lateral rib margin |
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bilary stenosis- |
aa |
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cholecystitis- |
aa |
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cholelithiasis- |
aa |
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cholegraphy- |
general term for radiographic exam of the biliary system |
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cholecystography- |
radiographic exam of the gallbladder |
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cholangiography- |
radiographic exam of the biliary ducts |
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what happens to choleliths when a patient is erect? |
the choleliths will stratify or layer out |
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OCG- |
(oral cholecystogram) oral administration of contrast |
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IVC- |
(introvenous cholangiography) introvenous administration of contrast |
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PTC- |
(percutaneous transhepatic cholangiography)direct injection of contrast |
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what exam for obstructive jaundice pts. |
PTC |
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operative/immediate cholangiogram |
aa |
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postoperative/delayed T-tube cholangiogram- |
aa |
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ERCP- |
(endoscopic retrograde cholangiopancreatography) |
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why do exams of the biliary tract? |
1. function of the liver- ability to remove contrast from blood and excrete it with bile 2. patency & condition of biliary ducts 3. concentrating and emptying ability of gallbladder 4. choleliths |
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choleliths- composition: (+)? (-)? |
calcium; cholesterol |
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ways to eliminate scatter |
good grids, close collimation |
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best way to reduce motion? |
short exposure time |
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what kVp should be used for exams of the biliary system? |
80 kVp |
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an operative/immediate cholangiogram procedure is usually performed where and with what equipment? |
in the OR with a C-arm |
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sometimes an operative cholangiogram is done after what other procedure? |
cholesystectomy |
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4 reasons for doing an operative/immediate cholangiogram? |
1. patency of ducts & status of Sphincter of Oddi 2. strictures or dilatation of ducts 3. check for choleliths 4. neoplasms |
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what side of the table does the C-arm come in the OR? |
opposite side of the surgeon |
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what may need to be done with C arm if patient is tilted or obliqued? |
may need to angle C arm |
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where is the injection done in operative cholangiogram? |
common bile duct |
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where should you center with the C-arm for the operative cholangiogram? |
over the patients right side |
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advantages to laproscopic cholangiogram |
1. less hospitalization time 2. done as an outpatient procedure 3. less invasive |
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open surgical immediate/operative cholangiogram where should you center? what technique should you use? |
RUQ; use an abdomen technique |
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what should you do if you do not see biliary drainage system draining into duodenum after taking first image? |
be ready to do another film |
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what does the post op/delayed or T tube cholangiogram show? |
bile ducts only |
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what are reasons for a post op/delayed T tube cholangiogram? |
check patency of ducts and look for choleliths |
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what shape tube is placed for a post op/ delayed cholangiogram? |
T shaped drainage tube (T tube) |
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how many ccs of contrast for T tube cholangiogram? what size syringe is used? |
50 cc contrast; 60 cc syringe |
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what is done to drainage tube the day prior to a t tube cholangiogram and why? |
drainage tube is clamped to allow tube to fill with bile |
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starting position for T tube cholangiogram |
supine |
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what kVp is used of images during a T tube cholangiogram? |
80 kvp |
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where do you center for the additional images of a t tube cholangiogram? |
center over area, right side |
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what position for PA t tube cholangiogram? |
supine |
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what is the oblique position and projection for T tube cholangiogram? |
RPO recumbent- AP oblique |
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how many degrees should you oblique the patient for t tube cholangiogram RPO? |
15-40* |
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how many degrees is pt obliqued for RPO T tube chole for hyper and asthenic? |
15* hypersthenic; 40* asthenic |
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what should you do to rid superimposition on an obliqued patient? |
increase obliquity |
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what type of contrast is used in the biliary system? |
iodinated water soluble |
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what type of exam uses pigtail cathetar? |
laparoscopic cholangiogram |
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what position best separates biliary ducts from the spine? |
RPO recumbent |
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if the pts. biliary ducts are seen superimposed over the spine in an obliqued position, what position it the patient in? |
LPO recumbent |
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where does contrast go to for T tube cholangiograms? |
decending duodenum |
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ERCP stands for what? |
endoscopic retrograde cholangiopancreatography |
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what does the ERCP show? |
biliary and hepatic ducts |
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where does the scope go for ERCP? |
from mouth to duodenum |
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where is contrast injected in an ERCP? |
hepatopancreatic ampulla |
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chole- |
relationship with bile |
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cysto- |
bag or sac |
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choledocho- |
common bile duct |
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cholangio- |
bile ducts |
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cholecyst- |
gallbladder |
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operative/immediate cholangiograms are performed during ___, after ___ and in the absence of ___ |
biliary tract surgery; bile has been drained from the ducts; obstruction |
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what is it called when solution is introduced into the common bile duct through an inlaying T tube? |
delayed operative or operative T tube cholangiography |
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when using C arm, where is the image intensifier placed; where is the xray tube placed? where is shielding placed? |
intensifier= above patient; tube= below patient; underneath the patient |
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what ducts are shown in an operative (immediate) cholangiogram? |
portion of the cystic duct, common hepatic duct, r and L hepatic duct, common bile duct and sometimes the pancreatic duct |
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why is the drainage tube clamped a day before the exam for a post operative T tube cholangiogram? |
to prevent air bubbles from entering the ducts |
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what pathology could air in the biliary ducts mimic? |
cholesterol stones |
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prep for post op T tube cholangiogram |
1. drainage tube is clamped 2. preceding meal is withheld 3. possible cleansing enema 1 hour before exam. |
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what is ERCP used to diagnose? |
biliary and pancreatic pathologies |
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ERCP is useful when? |
biliary ducts are not dilated and no obstuction exists in the ampulla |
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what is prohibited and for how long after procedure; why? |
no food or drink for one hour after procedure; local anesthetic causes temporary pharyngeal paresis |
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why would oblique images be taken during ERCP? |
to prevent overlap of the common bile duct and the pancreatic duct |
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how long after contrast is injected should it drain from normal ducts? |
5 minutes |
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true or false, patient sensitivity to iodine is a contraindication to its use in ERCP |
false |
