Hepatobiliary Radiographic Procedures PDF

HEPATO-BILIARY (GALLBLADDER & BILIARY DUCTS) SYSTEM RADIOGRAPHIC PROCEDURE Prof. Akram Asbeutah, PhD Department of Radiologic Sciences Faculty of Allied Health Sciences Kuwait University Objectives • Radiographic anatomy of GB & BD • Radiographic procedures of GB & BD • Radiographic positioning o...

HEPATO-BILIARY (GALLBLADDER & BILIARY DUCTS) SYSTEM RADIOGRAPHIC PROCEDURE Prof. Akram Asbeutah, PhD Department of Radiologic Sciences Faculty of Allied Health Sciences Kuwait University Objectives • Radiographic anatomy of GB & BD • Radiographic procedures of GB & BD • Radiographic positioning of GB & BD A- Radiographic AnatomyGallbladder & Biliary Ducts Radiographic Anatomy- Liver • It is the largest glandular organ & weighs 1.5 Kg • Below diaphragm-RUQ • Right (Larger), left lobes • Blood supply: – Portal vein – Hepatic artery • Gallbladder on right lobe Radiographic Anatomy- Liver Blood Supply • Hepatic portal vein – nutrient rich blood from stomach, spleen & intestines • Hepatic artery from branch off the aorta Radiographic Anatomy- Liver Lobes Functions of the Liver • Manufacture bile • Store glycogen, convert to glucose • Modify fats • Store vitamins, iron • Form blood plasma proteins • Destroy old red blood cells • Synthesize urea • Detoxify harmful substances Functions of the Liver- Bile Production • One quart of bile/day is secreted by the liver – yellow-green in color & pH 7.6 to 8.6 • Components – water & cholesterol – bile salts = Na & K salts of bile acids – bile pigments (bilirubin) from hemoglobin molecule • globin = a reuseable protein • heme = broken down into iron and bilirubin Radiographic Anatomy- Gallbladder & Biliary Ducts ▪ Gallbladder – fundus, body & neck – 7-10cm in length, 3 cm in width,& holds up to 50ml of bile ▪ Bile – Flows from liver through cystic duct – Is stored in gallbladder – Flows through cystic duct and common bile duct to duodenum when needed Radiographic Anatomy- Gallbladder & Biliary ducts Functions of Gallbladder Radiographic Anatomy- Common Bile Duct Anatomic Relationships of Gallbladder & Biliary Ducts Body Habitus & Gallbladder Location • A- hypersthenic: Gallbladder is higher and more lateral; it requires 15º-20º LAO position • B- Sthenic/hyposthenic: Gallbladder is halfway between xiphoid and lateral rib margin; it requires 20º-25º LAO position • C- Asthenic: Gallbladder is much lower near the iliac crest and near the midline; it requires 35º-50º LAO position B- Radiographic Procedures of Gallbladder & Biliary Ducts Radiographic Procedures of Gallbladder & Biliary Ducts • Cholecystogram • Cholangiogram • Cholecystocholangiogram Oral Cholecystogram (OCG) Procedure • OCG measures – The functional ability of the liver – The patency and condition of the biliary ducts – The concentrating & contracting ability of the GB Pathological Indications for OCG Contraindications for OCG Patient Preparation for OCG Patient Interview for OCG Imaging Routine Routine Positioning For OCG Functional Studies of the Gallbladder OCG- Anatomy Special Radiographic Biliary Duct Procedures • Intravenous Cholangiogram (IVC) • Percutaneous Transhepatic Cholangiogram (PTC) • Operative Cholangiogram • T-Tube Choalngioram • Endoscopic Retrograde Cholangiopancreaticogram (ERCP) Percutaneous Transhepatic Cholangiogram Percutaneous Transhepatic Cholangiogram Percutaneous Transhepatic Cholangiogram Percutaneous Transhepatic Cholangiogram Operative Cholangiogram Procedure Operative Cholangiogram Procedure Operative Cholangiogram Procedure Operative Cholangiogram Operative Cholangiogram Laparoscopic Cholangiogram Laparoscopic Cholangiogram T-Tube Cholangiogram T-Tube Cholangiogram Endoscopic Retrograde CholangiopancreatogramERCP Procedure Endoscopic Retrograde CholangiopancreatogramERCP Procedure RT Responsibilities during ERCP Endoscopic Retrograde CholangiopancreatogramERCP Procedure Endoscopic Retrograde CholangiopancreatogramERCP Procedure Summary of Biliary Studies C- Radiographic Positioning of Gallbladder & Biliary Ducts Radiographic Positioning of Gallbladder & Biliary Ducts PA Projection LAO Projection Right Lateral Decubitus (PA Projection) PA Erect Projection Alternative Modalities Radiographic Biliary Procedures • Ultrasound • Computed tomography (CTCP) • Magnetic resonance Cholangiograpancraticogram (MRCP) • Hida Nuclear Medicine Scan Role of Ultrasound Role of Ultrasound Role of Ultrasound Role of Ultrasound Role of CT It is effective in demonstrating neoplasms of liver, gallbladder , & pancreas. Stones can be demonstrated but because of radiation and cost US is often preferred. Role of MRI It is excellent modality for detecting neoplasms (Hepatocellular carcinoma, cholangiocarcinoma, hepatic metastasis, intrahepatic lymphoma, adenocarcinoma of the gallbladder) and biliary leak postoperative. Role of Nuclear MedicineHIDA Scan Patients are injected with radioactive isotope and images are taken 1-2 hours after injection. It can be done with CCK to indicate any response of the gallbladder to hormonal stimulation.