Liver Function and Biliary System Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which condition is indicated by elevated liver-function tests?

Staging known primary malignancy

Right upper-quadrant pain

Suspected portal hypertension

Hepatomegaly (correct)

What could be an underlying cause for right upper-quadrant pain?

Abnormal liver-function tests

Suspected focal liver lesion (correct)

Suspected portal hypertension

Characterization of a liver lesion

Which of the following symptoms is most directly associated with hepatomegaly?

Weight loss

Fever

Jaundice

Abdominal swelling (correct)

Which assessment would be necessary for the characterization of a liver lesion?

Ultrasound imaging Signup and view all the answers

What condition might indicate the need for staging a secondary malignancy?

Right upper-quadrant mass Signup and view all the answers

Which of the following is NOT considered a biliary abnormality?

Gallbladder stones Signup and view all the answers

What is the purpose of fasting for at least 6 hours before a cholangiographic procedure?

To prevent gallbladder contraction Signup and view all the answers

What volume of intravenous cholangiographic agent is typically administered?

100 mL Signup and view all the answers

Which of the following is a common technique for assessing biliary abnormalities?

Cholangiography Signup and view all the answers

Which of the following conditions is classified as a congenital abnormality in the biliary system?

Biliary atresia Signup and view all the answers

Why is it important to rescan the gallbladder in the left lateral decubitus or erect positions?

To avoid missing stones that may be detected in these positions. Signup and view all the answers

Which positioning technique can potentially enhance visualization of the neck and cystic ducts?

Head-down tilt. Signup and view all the answers

What might happen if only supine scanning of the gallbladder is performed?

There is a risk of missing gallstones. Signup and view all the answers

In which scenarios is it useful to employ the left lateral decubitus position for gallbladder scans?

When stones may be obscured in the supine position. Signup and view all the answers

Which of the following best describes the primary benefit of head-down tilt during gallbladder imaging?

Provides a clearer view of the neck and cystic ducts. Signup and view all the answers

What should be done if the duct is not entered on the first attempt?

Withdraw the needle tip to 2–3 cm from the liver capsule. Signup and view all the answers

Which direction is NOT suggested when repositioning the needle tip after a failed attempt?

Laterally Signup and view all the answers

What is the purpose of injecting contrast during the needle procedure?

To identify the duct entrance. Signup and view all the answers

When trying to enter a duct, how should the needle be manipulated if the first pass fails?

Withdraw and direct it in various specified directions. Signup and view all the answers

What distance should the needle tip be withdrawn to if the duct is not accessed initially?

2–3 cm Signup and view all the answers

Under what condition should the catheter be removed?

The radiologist is confident the patient can micturate. Signup and view all the answers

What circumstance allows for the catheter to remain in place?

No more contrast medium will drip into the bladder. Signup and view all the answers

What action should be taken if the patient cannot tolerate further infusion?

Remove the catheter immediately. Signup and view all the answers

What is a sign that the catheter may need to be removed?

The infusion of contrast medium has ceased. Signup and view all the answers

What factor should a radiologist consider before removing a catheter?

The patient's ability to micturate independently. Signup and view all the answers

What is a common practice regarding prophylactic broad-spectrum antibiotics?

They are routinely given in several centers. Signup and view all the answers

What is a primary complication associated with the use of contrast medium?

Allergic phenomena from circulation of contrast medium. Signup and view all the answers

Which statement about contrast medium complications is correct?

Allergic phenomena can occur when it is forced into circulation. Signup and view all the answers

Why are prophylactic broad-spectrum antibiotics considered good practice?

They prevent infections during procedures. Signup and view all the answers

What should clinicians be cautious of when using contrast mediums?

Potential allergic reactions especially with forced circulation. Signup and view all the answers

Study Notes

Methods of Imaging the Hepatobiliary System

Plain film: Not a routine indication, but may incidentally show air in the biliary tree or portal venous system, or opaque calculi or pancreatic calcification.
Ultrasound (US):
- Transabdominal
- Endoscopic
- Intraoperative
Computed Tomography (CT):
- Routine staging (portal venous phase) CT
- Triple-phase characterization CT
- CT cholangiography
Magnetic Resonance Imaging (MRI):
Endoscopic Retrograde Cholangiopancreatography (ERCP):
Percutaneous Transhepatic Cholangiography (PTC):
Operative Cholangiography:
Postoperative (T-tube) Cholangiography:
Angiography (diagnostic and interventional):
Radionuclide imaging:
- Static (with colloid)
- Dynamic (with iminodiacetic acid derivatives)

Methods of Imaging the Pancreas

Plain abdominal films: Not a routine indication, but may incidentally demonstrate air within the biliary tree or portal venous system, opaque calculi, or pancreatic calcification.
Ultrasound (US):
- Transabdominal
- Intraoperative
- Endoscopic
Computed Tomography (CT):
Magnetic Resonance Imaging (MRI):
ERCP:
Arteriography:
- Celiac axis
- Superior mesenteric artery

Ultrasound of the Liver

Indications:
- Suspected focal or diffuse liver lesion
- Jaundice
- Abnormal liver function tests
- Right upper-quadrant pain or mass
- Hepatomegaly
- Suspected portal hypertension
- Staging known extrahepatic malignancy (superseded by CT)
- Pyrexia of unknown origin (superseded by CT for patients over 30 years old)
- To provide real-time image guidance for biopsy needle placement
- Assessment of portal vein, hepatic artery or hepatic veins
- Assessment of patients with surgical shunts or TIPS procedures
- Follow-up after surgical resection or liver transplant
Patient Preparation: Fasting or restriction to clear fluids only required if gallbladder also to be studied.
Equipment: 3-5 MHz transducer and contact gel.
Technique: Patient supine. Longitudinal and transverse scans, additional scans if needed. Ultrasound of the liver uses microbubble agents to enable contrast enhancement of focal liver lesions, analogous to contrast-enhanced CT or MRI.

Computed Tomography of the Liver and Biliary Tree

Indications:
- Suspected focal or diffuse liver lesion
- Staging of known primary or secondary malignancy
- Abnormal liver function tests
- Right upper-quadrant pain or mass
- Hepatomegaly
- Suspected portal hypertension
- Characterization of liver lesion
- Pyrexia of unknown origin
- Biopsy needle placement
- Assessment of portal vein and hepatic vessels
- Patients with surgical shunts, TIPS procedures
- Post-surgical follow-up
Technique: Single-phase (portal phase) contrast-enhanced computed tomography. The liver is imaged during peak parenchymal enhancement (around 60-70 seconds after bolus injection). Oral contrast can be given but not always needed

Computed Tomographic Cholangiography

Indications:
- Screening for cholelithiasis
- Preoperative evaluation of anatomy
- Suspected traumatic bile duct injury
- Other biliary abnormalities (e.g., cholesterol polyps, adenomyomatosis)
Technique: Intra venous cholangiographic agent is used to opacify the biliary tree. Isotropic data from thin slices are reconstructed to provide high resolution 3D images.

Computed Tomography of the Pancreas

Indications:
- Suspected pancreatic tumor
- Pancreatitis or complications
- Epigastric mass
- Epigastric pain
- Jaundice
- Guided biopsy and/or drainage
Patient Preparation: Nil by mouth, preferably overnight.
Equipment: 3-5 MHz transducer and contact gel.
Technique: Patient supine. Identify the pancreas, and evaluate the head and tail. Use longitudinal and oblique scans. Evaluate the pancreatic parenchyma, which will increase in reflectivity with age.

Intraoperative Cholangiography

Indications: Performed during cholecystectomy or bile duct surgery to avoid surgical exploration of the common bile duct.
Contraindications: None
Contrast Medium: High osmolar or low osmolar contrast media (150-180 i.e. low iodine content to avoid obscuring any calculi). 20ml usually should suffice.
Equipment: Operating table with CR/DR or film cassette tunnel, mobile x-ray/imaging machine
Technique: Using a fine catheter, the surgeon cannulates the cystic duct with contrast medium, ensuring air bubbles are excluded. After 5 and 20ml of contrast inject images are taken.

Postoperative (T-Tube) Cholangiography

Indications: Exclude biliary tract calculi where operative cholangiography was not performed, or results unsatisfactory/suspect. Assess biliary leaks after biliary surgery.
Contraindications: None.
Contrast Medium: High osmolar or low osmolar contrast media (150 mg I mL-1; 20-30 mL).
Equipment: Fluoroscopy unit with spot image device.
Patient Preparation: Antibiotics may be required.

Percutaneous Transhepatic Cholangiography

Indications:
- Pre-therapeutic intervention for relief of obstructive jaundice, or to drain infected bile.
- To place a biliary stent.
Contraindications: None
Contrast Medium: High osmolar or low osmolar contrast media (150 mg/mL - 20-60 mL).
Equipment: Fluoroscopy unit with spot film device A 22G needle
Technique: Patient supine. A suitable duct in the right lobe is chosen. A 22g Chiba needle is inserted into the chosen duct under ultrasound or fluoroscopic guidance. Using a coaxial introducer system (over a 0.018 guidewire) the 0.035 guidewire allows access to the bile ducts. This is successful insertion, a sheath is inserted.

Percutaneous Extraction of Retained Biliary Calculi

Indications: Retained biliary calculi seen in T-tube cholangiogram (incidence 3%)
Contraindications: Small T-tube (<12-F), Tortuous T-tube course. Acute pancreatitis, presence of drain tract cross-connections.
Contrast Medium: High osmolar or low osmolar contrast media (150 mg I mL-1; 20-60 mL).
Equipment: Fluoroscopy unit with digital spot film device (tilting table optional), a fine, flexible, 22G needle (with stilette), appropriate catheters, and guidewire.
Technique: Coned supine PA image of the right side of the abdomen. Perform transhepatic extraction. The patient is supine . A 22G Chiba needle inserted into the liver parenchyma, under guidance of US or CT, with the needle slowly withdrawn. Contrast medium injected.

Methods of Imaging the Urinary Tract

Plain radiography: Predominantly to evaluate renal tract calcifications, with CT being more sensitive.
Excretion urography (IVU): Less frequently used now, largely replaced by US, CT, or MRI. Indications: haematuria, renal colic, recurrent urinary tract infection, loin pain, suspected urinary tract pathology.
Ultrasound (US): Can evaluate renal mass lesions, renal parenchymal disease, renal obstruction (loin pain), haematuria, hypertension, renal cystic disease, renal size, assessment of bladder outflow obstruction, urinary tract infections, and in patients following renal transplant.
Computed tomography (CT): Evaluates renal tract calcifications and other pathologies. Indications: renal colic/renal stone disease, renal tumour, renal/perirenal collection, loin mass, staging/follow-up of renal, collecting system, or prostatic cancers, investigation of renal tract obstruction, assessment of renal vessels for stenosis or fistula, or other malformations.
Magnetic resonance imaging (MRI): Can assess renal lesions, prostate, bladder, urography, adrenals, angiography , etcetera. Indications are similar to CT, although CT is often preferred due to availability, cost and time constraints.

Magnetic Resonance Imaging of the Prostate

Technique: Patient supine, phased-array body coil, endorectal coil.
Indications: Local staging of prostate and bladder cancers, pelvic lymph node staging, renal masses, screening/follow-up for individuals with Von Hippel-Lindau disease, MR urography if IV/CT urography contraindicated, Mr angiography assessing renal artery stenosis.

Retrograde Pyeloureterography & Hysterosalpingography

Indications: Demonstration of an obstructive lesion site and nature, evaluation/demonstration of the pelvicalyceal system if there are urothelial abnormalities, follow-up of tubal or post-sterilization surgery, and assessment of Caesarean section uterine scar problems.
Contraindications: Acute urinary tract infection.
Contrast Medium: High osmolar or low osmolar contrast media (150–200 mg I mL-1; 10 mL).
Technique: Performed in the operating theatre, via catheterization by a cystoscope (into the ureter) and contrast injection under fluoroscopic control.

Percutaneous Antegrade Pyelography and Nephrostomy

Indications: Renal tract obstruction, pyonephrosis, prior to percutaneous nephrolithotomy, and ureter or bladder fistulas.
Contraindications: Uncontrolled bleeding diathesis
Contrast Medium: High or low osmolar contrast material.
Equipment: Puncturing needle, drainage catheter, guidewires, and fluoroscopy or US machine

Renal Arteriography

Indications:
- Renal artery stenosis prior to angioplasty or stent placement
- Renal artery aneurysm, arteriovenous malformation, dissection or thrombosis
- Assessment of living-related renal transplant donors
- Embolization of vascular renal tumor prior to surgery
- Hematuria following trauma, including biopsy
- Pre-embolization of angiomyolipoma (AML) or therapeutic embolization of a bleeding AML.
Contrast Medium: Low osmolar contrast material.
Equipment: Fluoroscopy unit, pump injector, catheters. (Specific catheter choices are dependent on the specific type of procedure required.)

Methods of Imaging in the Female Reproductive System

Indications: Infertility to assess tubal patency, recurrent miscarriages, evaluation of suspected incompetent cervix/ congenital anomalies/uterus, post-sterilization obstruction, evaluation of Caesarean uterine scar integrity.
Contraindications: Period of menstruation, pregnancy or unprotected intercourse, suspected pelvic inflammatory disease (PID) in past 6 months, significant contrast sensitivity.
Equipment: Fluoroscopy unit, vaginal speculum, Vulsellum forceps and HSG balloon catheter or Margolin cannula for narrow cervical regions.

Ultrasound of the Scrotum

Indications: suspected testicular tumor, suspected epididymo-orchitis, hydrocele
Technique: Patient supine, with legs together for support. Scrotum examined with 7.5-15 MHz transducer and longitudinal and transverse scans.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on liver function tests, biliary abnormalities, and related medical imaging procedures. This quiz covers essential conditions, assessment techniques, and physiological principles important for understanding the liver and biliary system. Perfect for students and professionals in the medical field.