Cholegraphy and Contrast Agents

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Questions and Answers

What is the major risk associated with percutaneous transhepatic cholangiography (PTC)?

Pulmonary embolism

Kidney failure

Nerve damage

Liver hemorrhage (correct)

Which statement accurately describes a procedure that uses a duodenoscope?

It is primarily used for liver biopsies.

It is used solely for diagnostic purposes.

It requires the patient to be fasting for at least 6 hours.

It can relieve pathologic conditions by removing choleliths. (correct)

What is the purpose of clamping the T-tube catheter after insertion into the common bile duct?

To enhance imaging quality

To prevent bile leakage (correct)

To facilitate blood flow

To assist in needle fixation

What precaution is essential to take before performing an ERCP?

Reviewing the patient’s medical history for pancreatitis Signup and view all the answers

During a PTC procedure, what is injected into the biliary ducts after the needle is positioned?

Contrast medium (CM) Signup and view all the answers

What is the primary purpose of performing a choledochography?

Assess liver function and bile excretion Signup and view all the answers

Which of the following methods is NOT a route for contrast agent administration?

Inhalation through the lungs Signup and view all the answers

What is an indication for performing a cholangiogram?

Cholecystitis Signup and view all the answers

What should a patient eat the day before a gallbladder exam?

Fat-free diet followed by fatty foods Signup and view all the answers

Which of the following is a contraindication for performing cholegraphy?

Severe jaundice Signup and view all the answers

What does the presence of black calculi in the gallbladder suggest?

Pure cholesterol stones Signup and view all the answers

What is the purpose of the PA projection scout film in gallbladder imaging?

To determine the presence and location of the gallbladder Signup and view all the answers

Which type of cholegraphy focuses on the visualization of bile ducts specifically?

Cholangiography Signup and view all the answers

Which imaging routine aligns the patient's mid-sagittal plane to the table's long axis?

Prone position Signup and view all the answers

Which of the following statements about bile duct contrast media is true?

Iodine-based compounds may cause hypersensitivity reactions. Signup and view all the answers

In operative cholangiography, what is used to introduce contrast media into the cystic duct?

A small catheter Signup and view all the answers

How long before the gallbladder exam should laxatives be avoided?

24 hours Signup and view all the answers

What is the role of the gallbladder in relation to the contrast agent?

It stores bile, which contains the contrast agent. Signup and view all the answers

How are cholycystangography and cholangioography primarily differentiated?

By the area of the biliary tract examined Signup and view all the answers

What should be ensured during the patient interview prior to a gallbladder exam?

The patient has not had breakfast Signup and view all the answers

Which projection helps project the gallbladder away from the vertebral column for better visibility?

LAO Signup and view all the answers

What is the primary goal of post-operative cholangiography?

To detect residual stones in the biliary ducts Signup and view all the answers

What must be the patient's positioning for a right lateral decubitus projection?

Lying on the right side facing the IR Signup and view all the answers

Study Notes

Cholegraphy

A general term for radiologic exam of the biliary tract using radiopaque contrast agents (C.A.)
Cholecystangiography or cholecystocholangiography: refers to the examination of the gallbladder and bile ducts
Cholecystography: specifically for the gallbladder
Cholangiography: specifically for the bile ducts

Administration of C.A

Oral: C.A. is taken orally
IV: Injection of C.A. directly into the vein, either as a single bolus or drip infusion
Direct injection into the ducts:
- Percutaneous transhepatic puncture: going through the liver
- During biliary tract surgery: either during or immediately after surgery
- Through an indwelling drainage tube: post-operative, delayed or T-tube

Methods of Examination

Classified based on:
- Route of entry for contrast media
- Portion of the biliary tract examined

Route of C.A

Oral: C.A. passes through the intestines and into the liver via the portal veins
IV: C.A. travels in the bloodstream and is excreted with bile, reaching the gallbladder via the biliary system

Purposes of Cholegraphy

Assess liver function: ability to remove C.A. from the blood and excrete it with bile
Determine the patency (openness) and condition of the biliary ducts
Evaluate gallbladder concentrating and emptying capabilities
Identify calculi (stones):
- Pure cholesterol: appears black (50-60% of stones)
- Calcified: appears white (10-15%)

Oral Cholecystography

Administration: 4-6 tablets or capsules taken the evening before the exam
Alternative name: Cholecystopaques
Contraindications:
- Advanced hepatorenal disease (severe jaundice, acute/chronic liver failure, renal failure, hepatocellular disease)
- Active gastrointestinal disease (vomiting, severe diarrhea, malabsorption syndrome)
- Hypersensitivity to iodine-containing compounds
- Pregnancy

Indications for Cholegraphy

Choledocholethiasis (stones in the common bile duct)
Cholelithiasis (gallstones)
Milk calcium bile
Cholecystitis (inflammation of the gallbladder)
Neoplasms (tumors)
Biliary stenosis (narrowing of the bile ducts)
Congenital anomalies (birth defects)

Patient Preparation for Oral Cholecystography

Dietary: Start a fat-free diet 1-2 days before the exam; Eat fatty foods the day before the exam at noon
Laxatives: Avoid 24 hours before the exam
Light evening meal: No fat or fried foods
NPO (nothing by mouth): Before the exam
C.A intake: Take 4-6 capsules after the evening meal, but before 9 PM
No breakfast: On the morning of the exam
Report to x-ray department: In the morning

Patient Interview for Oral Cholecystography

Number of pills: How many were taken and at what time?
Reactions: Did the patient experience any reactions to the pills?
Breakfast: Did the patient have breakfast?
Gallbladder presence: Has the patient had their gallbladder removed?
Pregnancy: For female patients of childbearing age, ask about pregnancy.

Imaging Routine for Oral Cholecystography

Scout: PA projection (10x12 or 14x17)
- Purpose: Determine presence and location of the gallbladder, identify choleliths, assess C.A. concentration, and confirm proper exposure factors
- Some departments may require a full abdomen, centering the PA at the level of the iliac crest or slightly above

Positioning for Oral Cholecystography

Prone:
- Position: Align MSP with the long axis of the table, centering the right side of the abdomen
- CR: Perpendicular to IR
- CR level: L2 for average sthenic patients, ½ to 1” above the lowest margin of the rib cage
- IR centered to CR
- Instructions: Suspended respiration, focusing on the gallbladder and the cystic duct area
- SS: Opacified region
LAO (10x12 lengthwise):
- Position: Semiprone, left side down
- Rotation: 15-40° (less for hyperstenic, more for asthenic patients)
- CR: Perpendicular
- Instructions: Suspended respiration upon expiration
- SS: Same as prone
Right Lateral Decubitus (10x12 lengthwise):
- Position: Patient lying on right side facing the IR, supported by radiolucent pads
- CR: Horizontal
- Instructions: Suspended respiration upon expiration
- SS: Provides visualization of the gallbladder away from the vertebrae, stratifying stones
PA Erect (10x12 lengthwise):
- Position: Patient erect facing the VGCH
- CR: Horizontal
- Instructions: Suspended respiration upon expiration
- SS: Entire opacified gallbladder and the cystic duct area

Operative (Immediate) Cholangiography

Performed during surgery
Purposes:
- Identify any missed stones
- Evaluate the patency of the biliary ducts
- Determine the status of the papilla of Vater
- Identify lesions (strictures, dilatations) in the ducts
Procedure:
- Contrast media is injected through a catheter inserted into the cystic duct

Post-Operative (T-Tube or Delayed) Cholangiography

Performed after cholecystectomy (gallbladder removal)
T-tube: A specific catheter inserted into the common bile duct, extending outside the body

Percutaneous Transhepatic Cholangiography (PTC)

Direct puncture of the biliary ducts through the liver tissue
Risks: Liver hemorrhage, pneumothorax (collapsed lung), bile leakage
Procedure:
- Needle insertion into the liver, guided by fluoroscopy
- Contrast media is injected into the duct

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Therapeutic and diagnostic procedure
Endoscope used: Duodenoscope
Therapeutic: Relief of pathologic conditions, stone removal, lesion removal, stenosis repair
Diagnostic: Injection of contrast media into the biliary ducts, guided by fluoroscopy

ERCP Precautions

NPO: 1 hour or more before the procedure
Patient history: Review for pancreatitis or pseudocyst of the pancreas
Radiation protection: Ensure all individuals in the fluoroscopy room wear protective aprons

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Description

This quiz explores the various types of cholegraphy, focusing on the procedures, administration methods, and routes for contrast agents. It covers important distinctions in biliary tract imaging, including cholecystography and cholangiography. Test your knowledge on these radiologic exams and their applications.