Gallbladder and Biliary Ducts

1
Chapter 16

• Gallbladder and Biliary Ducts

2
The Liver

• Largest ________________in the body
• Has many functions
• Manufactures _______ and sends it to the
  ________________ (800-1000ml per day)

3
Liver

• 4 Total Lobes
• 2 major lobes
• Right and Left
• Separated by _____________
• 2 minor lobes
• ____________________

4
Terminology

• ___________ relating to bile
• ___________ relating to a sac or bladder
• _____________ Radiograph of the gall bladder

5
Gallbladder

• Pear shaped with 3 parts
• __________ - Distal
• __________ Main section
• __________ Proximal
• ______________-Connects Gallbladder to Common
  Bile Duct

6
Gallbladder

• Stores ________
• _______________ bile
• Contract bile
• When stimulated by fatty foods in duodenum by
  ____________________________

7
Gallbladder location

• Anterior to midcoronal plane
• _______________
• More lateral and higher
• __________________
• Between xiphoid tip and lower lateral rib
  margin
• __________________
• Mid sagittal and lower

8
Biliary Ducts

• Right and left _____________
• Transport bile from liver to common hepatic
• ___________________
• Transports bile to gallbladder or to common bile
  duct
• __________________
• Transports bile to duodenum

9
Additional Ducts

• _____________
• Passage from gallbladder to CBD
• ______________
• Transports pancreatic enzymes to CBD

10
Common Bile Duct

• 7.5 cm long
• Distal to the _______________
• Converges with the _____________

11
Distal Common Bile Duct

• ________________
• Hepatopancreatic ampulla
• ___________________
• Duodenal papilla ________________

12
Imaging the Gallbladder

• Laparoscopic Cholecystectomy _________________
• Operative Cholangiogram
• Endoscopic Retrograde Cholangiopancreatography
  ____________

13
Older imaging methods

• Oral Cholecystogram (OCG)
• Percutaneous Transheptic Cholangiography (PTC)
• T-Tube Cholangiography

14
Operative Cholangiogram

• In OR
• With ___________
• Images when surgeon indicates
• Surgeon to move patient if needed
• Possible ___________post op

15
Laparoscopic Cholecystectomy

• Same rules as OR
• Removal of ______________
• Surgeon inserts tube into __________
• With C-arm image when indicated

16
ERCP

• Endoscopic
• Retrograde
• Cholangio
• Pancreatography

17
ERCP Purpose

• Asses pathologies of _________and/or pancreatic
  duct systems.
• Can be theraputic
• ______________
• Stone removal
• ______________
• Can Asses Pancreatic Cancer

18
ERCP Procedure

• Done by gastroenterologist
• ______________
• Endo nurse
• ________________
• Endoscope inserted to find ____________
• Catheter inserted to _________
• Contrast injected

19
Your Role

• Provide a clean room for the endo personnel
• Pt placed _____________
• Provide
• ______________
• ______________
• Padded table with sheets / towels / pillows

20
Imaging in ERCP

• Scout
• Fluoro
• Spot film
• Post procedure ________ (Usually prone)
• Or any other images the gastro or rad wants

21
Complications

• _______________
• Infection due to rupture of pancreatic pseudocyst
• Drug reactions
• Breathing complications
• ________________of upper GI by endoscope
• ALL YOU DO IS HELP IF NEEDED
• ______________
• Get yourself and _____________ out of the way

22
Positioning for Gallbladder

• Routine
• AP or PA 14 x 17
• RPO 10 x 12
• LAO 10 x 12
• RLD 10 x 12
• 75 kVp
• 40 SID

23
AP or PA

• Scout film and possibly with routine
• CR mid sagittal
• ___________________
• Suspend respiration

24
LAO

• ______________________
• CR to Gall bladder
• Locate mid sagittal plane and ____________________
  ________
• Or mid __________rib

25
RPO

• _______________ based on body habitus
• CR directed to gallbladder
• Locate mid sagittal plane and center to half of
  rt. sagittal plane
• Or center to mid Rt. _________rib
• Places gallbladder ________________

26
RLD

• Place pt on right side
• Place ____________on anterior aspect of pt
• CR based on scout or fluoro
• Or Rt side (down side) ______________
• Will __________gall stones if present