Radiographic Technique II AMRR 221 PDF

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (8) Biliary System • Ultrasound imaging is normally undertaken to demonstrate the biliary system. • Plain radio...

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (8) Biliary System • Ultrasound imaging is normally undertaken to demonstrate the biliary system. • Plain radiographs of the biliary system may be taken to demonstrate opacities, including calcifications in the region of the gallbladder and biliary tree. Pt Prep: • Laxatives and a diet may be taken during the two days before the examination to clear overlying faeces and bowel gas. ‫ﺔ ﻹﻇﻬﺎر اﻟﺠﻬﺎز اﻟﺼﻔﺮاوي‬Z‫ﺎﻟﻤﻮﺟﺎت ﻓﻮق اﻟﺼﻮﺗ‬b ‫ﺮ‬cd‫ﻋﺎدة ﻣﺎ ﻳﺘﻢ إﺟﺮاء اﻟﺘﺼ‬. • ‫ﺔ‬c‫ﻠﺲ ﻓﻲ ﻣﻨﻄﻘﺔ اﻟﻤﺮارة واﻟﺸﺠﺮة اﻟﺼﻔﺮاو‬u‫ﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺘ‬b ،‫ﻢ‬Z‫ﺔ واﺿﺤﺔ ﻟﻠﺠﻬﺎز اﻟﺼﻔﺮاوي ﻹﻇﻬﺎر اﻟﺘﻌﺘ‬Z‫ﻤﻜﻦ أﺧﺬ ﺻﻮر ﺷﻌﺎﻋ‬ƒ. • ‫ﺔ‬ƒ‫ اﻹﻋﺪاد‬Pt: • ‫ﻤﻦ وﻏﺎز اﻷﻣﻌﺎء‬u‫ﻘﻴﻦ ﻟﻠﻔﺤﺺ ﻹزاﻟﺔ اﻟﺒﺮاز اﻟﻤ‬b‫ﻤﻜﻦ ﺗﻨﺎول اﻟﻤﺴﻬﻼت واﻟﻨﻈﺎم اﻟﻐﺬاﺋﻲ ﺧﻼل اﻟﻴﻮﻣﻴﻦ اﻟﺴﺎ‬ƒ. • • In order to be able to differentiate soft tissues in the region, the radiographic image must be sharp and have the maximum possible contrast. Factors used to give maximum image quality are: ‫ \ﺠﺐ أن ﺗﻜﻮن اﻟﺼﻮرة‬،‫ﺴﺠﺔ اﻟﺮﺧﻮة ﻓﻲ اﻟﻤﻨﻄﻘﺔ‬h‫• ﻟﻜﻲ ﺗﻜﻮن ﻗﺎدرا ﻋﻠﻰ اﻟﺘﻤﻴﻴﺰ ﺑﻴﻦ اﻷ‬ .‫ﺎﻳﻦ ﻣﻤﻜﻦ‬w‫اﻟﺸﻌﺎﻋ|ﺔ ﺣﺎدة وﻟﺪﻳﻬﺎ أﻗﺼﻰ ﺗ‬ 1.Immobilization. :‫• اﻟﻌﻮاﻣﻞ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻹﻋﻄﺎء أﻗﺼﻰ ﺟﻮدة ﻟﻠﺼﻮرة ﻫﻲ‬ 2.Compression. .‫• اﻟﺸﻠﻞ‬ 3.Collimation. .‫• ﺿﻐﻂ‬ 4.Short exposure time with high mA = Opt mAs .‫• ﺗﻮاﻃﺆ‬ Opt mAs = ‫ اﻟﻌﺎﻟﻲ‬mA ‫• وﻗﺖ اﻟﺘﻌﺮض اﻟﻘﺼﻴﺮ ﻣﻊ‬ 5.Low kilovoltage (70 kVp). .(‫ ﻛ|ﻠﻮﻓﻮﻟﺖ‬70) ‫• ﻛ|ﻠﻮﻓﻮﻟﺘﺎج ﻣﻨﺨﻔﺾ‬ Left anterior oblique • The cassette size is large to cover region of the right side of the abdomen. • The patient lies prone. The right side is raised, rotating the median sagittal plane through an angle of 20 degrees. • The arm on the raised side is flexed, while the left arm lies alongside and behind the trunk. Left anterior oblique .‫ﻄﻦ‬w‫• ﺣﺠﻢ اﻟ—ﺎﺳ•ﺖ ﻛﺒﻴﺮ ﻟﺘﻐﻄ|ﺔ ﻣﻨﻄﻘﺔ اﻟﺠﺎﻧﺐ اﻷ\ﻤﻦ ﻣﻦ اﻟ‬ .‫ درﺟﺔ‬20 ‫ وﺗﺪو™ﺮ اﻟﻤﺴﺘﻮى اﻟﺴﻬﻤﻲ اﻟﻤﺘﻮﺳﻂ ﺑﺰاو™ﺔ‬،‫ ﻳﺘﻢ رﻓﻊ اﻟﺠﺎﻧﺐ اﻷ\ﻤﻦ‬.‫• اﻟﻤ•™ﺾ \ﻜﺬب ﻋﺮﺿﺔ‬ .‫ ﺑ¡ﻨﻤﺎ ﺗﻘﻊ اﻟﺬراع اﻟ•ﺴﺮى ﺠﺎﻧﺐ اﻟﺠﺬع وﺧﻠﻔﻪ‬،‫• ﻳﺘﻢ ﺛﻨﻲ اﻟﺬراع ﻋﻠﻰ اﻟﺠﺎﻧﺐ اﻟﻤﺮﺗﻔﻊ‬ CR :CP •The vertical central ray is directed to a point 7.5 cm to the right of the spinous processes and 2.5 cm above the lower costal margin and to the centre of the cassette. •The exposure is made on arrested respiration after full expiration. CP :CR .‫ ﺳﻢ ﻓﻮق اﻟﻬﺎﻣﺶ اﻟﺴﺎﺣﻠﻲ اﻟﺴﻔﻠﻲ و•ﻟﻰ ﻣﺮﻛﺰ اﻟ™ﺎﺳ—ﺖ‬2.5‫ﺔ و‬Z‫ﺎت اﻟﺸﻮﻛ‬Z‫ﻤﻴﻦ اﻟﻌﻤﻠ‬ƒ ‫ ﺳﻢ إﻟﻰ‬7.5 ‫ﺔ إﻟﻰ ﻧﻘﻄﺔ‬ƒ‫ﺔ اﻟﻌﻤﻮد‬c¡‫ﻪ اﻷﺷﻌﺔ اﻟﻤﺮﻛ‬Z‫ﻳﺘﻢ ﺗﻮﺟ‬ .‫ﺎﻟ™ﺎﻣﻞ‬b ‫ﺔ‬Z‫ﻌﺪ اﻧﺘﻬﺎء اﻟﺼﻼﺣ‬b ‫ﻳﺘﻢ اﻟﺘﻌﺮض ﻟﻠﺘﻨﻔﺲ اﻟﻤﻌﺘﻘﻞ‬ 1- Oral Cholecystogram (O.C.G) • It is the contrast examination of the gall bladder, billiary and cystic duct. Indications for imaging O.C.G : 1.Lazy gallbladder. 2.Atonic GB. 3.GB stone. 4.Multiple diverticulum of the GB. Contraindication(O.C.G) 1. Abnormality in oesophagus. 2. Pyloric stenosis. 3. Infective hepatitis. 4. Liver cell destruction. 5. Stone in C.H.D. 6. Malabsorption in the small intestine. 7. Portal vein thrombus. 8. Tumor. (G.C.O) ‫ﻖ اﻟﻔﻢ‬c¬‫ ﻣﺨﻄﻂ اﻟﻤﺮارة ﻋﻦ ﻃ‬-1 .‫ﺔ‬Z‫—ﺴ‬°‫ﺔ واﻟ‬c‫ﺎﻳﻦ ﻟﻠﻤﺮارة واﻟﻘﻨﺎة اﻟﺼﻔﺮاو‬±‫إﻧﻪ ﻓﺤﺺ اﻟﺘ‬ :G.C.O ‫ﺮ‬cd‫ﻣﺆﺷﺮات اﻟﺘﺼ‬ .‫ﺴﻮﻟﺔ‬°‫اﻟﻤﺮارة اﻟ‬ .‫ﻚ ﺟﻲ ﺑﻲ‬Z‫أﺗﻮﻧ‬ .GB ‫ﺣﺠﺮ‬ .‫اﻟﺮﺗﺞ اﻟﻤﺘﻌﺪد ﻟﻠﺠﻲ ﺑﻲ‬ (G.C.O) ‫ﻣﻮاﻧﻊ اﻻﺳﺘﻌﻤﺎل‬ .‫اﻟﺸﺬوذ ﻓﻲ اﻟﻤﺮيء‬ .‫ﻠﻮري‬Z‫ﺗﻀﻴﻖ ﺑ‬ .‫ﺪ اﻟﻤﻌﺪي‬±°‫اﻟﺘﻬﺎب اﻟ‬ .‫ﺪ‬±°‫ﺎ اﻟ‬ƒ‫ﺗﺪﻣﻴﺮ ﺧﻼ‬ .D.H.C ‫ﺣﺠﺮ ﻓﻲ‬ .‫ﻘﺔ‬Z‫ﺳﻮء اﻻﻣﺘﺼﺎص ﻓﻲ اﻷﻣﻌﺎء اﻟﺪﻗ‬ .‫ﺎﺑﻲ‬±‫ﺪ اﻟ‬c‫ﺧﺜﺮة اﻟﻮر‬ .‫ورم‬ Technique: :‫ﺔ‬Z‫اﻟﺘﻘﻨ‬ Patient preparation 1. The patient takes a laxative for two days prior to the examination days. 2. Avoid milk and egg and smell of food. 3. Drink fluids. Plain film • A single control radiograph of the whole abdomen or the right side of the abdomen to demonstrate: 1. Any radio opaque calculi. 2. Evaluate the laxative preparation. 3. Judge the exposure for the second part of the examination. Contrast • Iodine containing substance (BILOPTIN) Amount • 9-12 tablets. • The evening before the examination the patient takes the oral contrast (Biloptin), and remains Nil by mouth except for water until the examination (14 hours after taking the contrast medium). ‫ﺾ‬c¬‫إﻋﺪاد اﻟﻤ‬ .‫ﺎم اﻟﻔﺤﺺ‬ƒ‫ﻞ أ‬±‫ﺾ ﻣﻠﻴﻨﺎ ﻟﻤﺪة ﻳﻮﻣﻴﻦ ﻗ‬c¬‫ﺄﺧﺬ اﻟﻤ‬ƒ .‫ﺾ وراﺋﺤﺔ اﻟﻄﻌﺎم‬Z‫ﺐ واﻟﺒ‬Z‫ﺗﺠﻨﺐ اﻟﺤﻠ‬ .‫اﺷﺮب اﻟﺴﻮاﺋﻞ‬ ‫ﻠﻢ ﻋﺎدي‬Z‫ﻓ‬ ‫ﻤﻠﻪ أو اﻟﺠﺎﻧﺐ‬À‫ﺄ‬b ‫ﻄﻦ‬±‫ﻢ ﻓﻲ اﻟ‬u‫ﺔ واﺣﺪة ﻟﻠﺘﺤ‬Z‫ﺻﻮرة ﺷﻌﺎﻋ‬ :‫ﻄﻦ ﻹﻇﻬﺎر‬±‫ﻤﻦ ﻣﻦ اﻟ‬ƒ‫اﻷ‬ .‫أي ﺣﺴﺎب ﺣﺴﺎب ﻻﺳﻠﻜﻲ ﻣﺒﻬﻢ‬ .‫ﻢ اﻟﺘﺤﻀﻴﺮ اﻟﻤﻠﻴﻦ‬Z‫ﻗﻢ ﺑﺘﻘﻴ‬ .‫ﻢ ﻋﻠﻰ اﻟﺘﻌﺮض ﻟﻠﺠﺰء اﻟﺜﺎﻧﻲ ﻣﻦ اﻟﻔﺤﺺ‬u‫ﺎﻟﺤ‬b ‫ﻗﻢ‬ ‫ﺎﻳﻦ‬±‫ﺗ‬ (‫ﺘﻴﻦ‬Ád‫ﻠ‬Z‫ﻣﺎدة ﺗﺤﺘﻮي ﻋﻠﻰ اﻟﻴﻮد )ﺑ‬ ‫ﻗﺪر‬ .‫ ﻗﺮﺻﺎ‬12-9 ‫ﺎﻳﻦ اﻟﻔﻤﻮي‬±‫ﺾ اﻟﺘ‬c¬‫ﺄﺧﺬ اﻟﻤ‬ƒ ،‫ﻞ اﻟﻔﺤﺺ‬±‫ﻓﻲ اﻟﻤﺴﺎء ﻗ‬ ‫ﺜﻨﺎء اﻟﻤﺎء‬Ã‫ﺎﺳ‬b ‫ﻖ اﻟﻔﻢ‬c¬‫ﻘﻰ ﻻ ﺷﻲء ﻋﻦ ﻃ‬±c‫ و‬،(‫ﺘﻴﻦ‬Ád‫ﻠ‬Z‫)ﺑ‬ .(‫ﺎﻳﻦ‬±‫ﻌﺪ ﺗﻨﺎول وﺳﻂ اﻟﺘ‬b ‫ ﺳﺎﻋﺔ‬14) ‫ﺣﺘﻰ اﻟﻔﺤﺺ‬ The day of the examination: • Check the patient has taken the tablets. • A typical film sequence is an erect and Prone image the gall bladder region with the patient positioned in the left anterior oblique (LAO) position. Fatty Meal Film • A fatty meal is given (a glass of full fat milk) 40 minutes later the gall bladder is imaged in which projection best demonstrated it in the first two films. ::‫ﻳﻮم اﻻﻣﺘﺤﺎن‬ .‫ﺾ ﻗﺪ ﺗﻨﺎول اﻷﻗﺮاص‬c¬‫ﺗﺤﻘﻖ ﻣﻦ أن اﻟﻤ‬ ‫ﺔ وﻋﺮﺿﺔ‬±‫ﻠﻢ اﻟﻨﻤﻮذﺟﻲ ﻫﻮ ﺻﻮرة ﻣﻨﺘﺼ‬Z‫ﺴﻠﺴﻞ اﻟﻔ‬È ‫ﺾ ﻓﻲ اﻟﻮﺿﻊ اﻟﻤﺎﺋﻞ‬c¬‫ﻟﻤﻨﻄﻘﺔ اﻟﻤﺮارة ﻣﻊ وﺿﻊ اﻟﻤ‬ .(LAO) ‫ﺴﺮ‬É‫اﻷﻣﺎﻣﻲ اﻷ‬ ‫ﺔ‬Z‫ﺔ دﻫﻨ‬±‫ﻠﻢ وﺟ‬Z‫ﻓ‬ ‫ﺎﻣﻞ‬Ê ‫ﺐ‬Z‫ﺔ )ﻛﻮب ﻣﻦ اﻟﺤﻠ‬Z‫ﺔ دﻫﻨ‬±‫ﻳﺘﻢ إﻋﻄﺎء وﺟ‬ ‫ﺚ‬Z‫ﺮ اﻟﻤﺮارة ﺣ‬cd‫ﻘﺔ ﻳﺘﻢ ﺗﺼ‬Z‫ دﻗ‬40 ‫ﻌﺪ‬b (‫اﻟﺪﺳﻢ‬ .‫ﻠﻤﻴﻦ اﻷوﻟﻴﻦ‬Z‫ﻞ أﻓﻀﻞ ﻓﻲ اﻟﻔ‬u‫ﺸ‬Ì ‫أﻇﻬﺮﻫﺎ اﻹﺳﻘﺎط‬ .:‫اﻟﻤﻀﺎﻋﻔﺎت‬ Complications: • GI disturbance is common. • Urticarial skin reactions and vasodilation are rare. .‫اﺿﻄﺮاب اﻟﺠﻬﺎز اﻟﻬﻀﻤﻲ ﺷﺎﺋﻊ‬ .‫ﺔ ﻧﺎدرة‬Z‫ وﺗﻮﺳﻴﻊ اﻷوﻋ‬Urticarial ‫ﺗﻔﺎﻋﻼت اﻟﺠﻠﺪ‬ ‫ﺘﺞ أﻟﻢ ﺣﺎد إذا أﺻﺒﺢ ﺣﺴﺎب اﻟﺘﻔﺎﺿﻞ‬Ï‫ﻗﺪ ﻳ‬ ‫ﻌﺪ‬b ‫ﺔ‬Z‫—ﺴ‬°‫ﺎﻣﻞ )اﻟﺤﺠﺮ( ﻧﺰﻻ ﻓﻲ اﻟﻘﻨﺎة اﻟ‬u‫واﻟﺘ‬ .‫ﺔ‬Z‫ﺔ اﻟﺪﻫﻨ‬±‫اﻟﻮﺟ‬ • Acute pain may result if a calculus(stone) becomes lodges in the cystic duct following the fatty meal. • Impaired renal function. .‫ﺿﻌﻒ وﻇﺎﺋﻒ اﻟ™ﻠﻰ‬ 2- T-TUBE CHOLANGIOGRAM Introduction • A T-tube cholangiogram is a fluoroscopic procedure in which contrast medium is injected through a T-tube into the biliary tree. • The T-tube is most commonly inserted during a cholecystectomy operation when there is a possibility of residual gall stones within the biliary tree. ‫ﻢ‬ƒ‫ﺗﻘﺪ‬ .‫ﺔ‬c‫ ﻓﻲ اﻟﺸﺠﺮة اﻟﺼﻔﺮاو‬T ‫ﺎﻳﻦ ﻣﻦ ﺧﻼل أﻧﺒﻮب‬±‫ﻪ ﺣﻘﻦ وﺳﻂ اﻟﺘ‬Z‫ﺎﻟﻤﻨﻈﺎر اﻟﻔﻠﻮري ﻳﺘﻢ ﻓ‬b ‫ ﻫﻮ إﺟﺮاء‬T ‫ﺔ ﻟﻸﻧﺒﻮب‬c‫ﺔ اﻟﺼﻔﺮاو‬Z‫ﻣﺨﻄﻂ اﻷﻗﻨ‬ .‫ﺔ‬c‫ﺔ داﺧﻞ اﻟﺸﺠﺮة اﻟﺼﻔﺮاو‬Z‫ﻘ‬±‫ﻜﻮن ﻫﻨﺎك اﺣﺘﻤﺎل ﻟﺤﺼﻰ اﻟﻤﺮارة اﻟﻤﺘ‬ƒ ‫ﺌﺼﺎل اﻟﻤﺮارة ﻋﻨﺪﻣﺎ‬Ã‫ﺔ اﺳ‬Z‫ﺜﺮ ﺷﻴﻮﻋﺎ أﺛﻨﺎء ﻋﻤﻠ‬Õ‫ﻞ أ‬u‫ﺸ‬Ì ‫ﺔ‬Z‫ﻳﺘﻢ إدﺧﺎل اﻷﻧﺒﻮب اﻟﺘﺎﺋ‬ Indications • Possibility of residual small gallstones post cholecystectomy. • Obstructive jaundice. • Bile duct stricture. • Surgeon unable to explore bile duct during cholecystectomy surgery Contraindications • Non-consent by patient. • Contrast or iodine allergy. .‫ﻣﺆﺷﺮات‬ .‫ﺌﺼﺎل اﻟﻤﺮارة‬Ã‫ﻌﺪ اﺳ‬b ‫ﺔ‬Z‫ﻘ‬±‫ﺔ ﺣﺼﻰ اﻟﻤﺮارة اﻟﺼﻐﻴﺮة اﻟﻤﺘ‬Z‫ﺎﻧ‬u‫إﻣ‬ .‫ﺴﺪادي‬Ö‫اﻟﻴﺮﻗﺎن اﻻ‬ .‫ﺔ‬c‫ﺗﻀﻴﻖ اﻟﻘﻨﺎة اﻟﺼﻔﺮاو‬ ‫ﺔ أﺛﻨﺎء ﺟﺮاﺣﺔ‬c‫ﺟﺮاح ﻏﻴﺮ ﻗﺎدر ﻋﻠﻰ اﺳﺘﻜﺸﺎف اﻟﻘﻨﺎة اﻟﺼﻔﺮاو‬ ‫ﺌﺼﺎل اﻟﻤﺮارة‬Ã‫اﺳ‬ ‫ﻣﻮاﻧﻊ اﻻﺳﺘﻌﻤﺎل‬ .‫ﺾ‬c¬‫ﻋﺪم ﻣﻮاﻓﻘﺔ اﻟﻤ‬ .‫ﺎﻳﻦ أو اﻟﻴﻮد‬±‫ﺔ اﻟﺘ‬Z‫ﺣﺴﺎﺳ‬ • Pregnancy (pregnancy test required). .(‫ﺎر اﻟﺤﻤﻞ ﻣﻄﻠﻮب‬±‫اﻟﺤﻤﻞ )اﺧﺘ‬ • Barium study within last 3 days. .‫ﺎم‬ƒ‫ أ‬3 ‫ﻮم ﺧﻼل آﺧﺮ‬c‫ﺎر‬±‫دراﺳﺔ اﻟ‬ Preparation ‫إﻋﺪاد‬ ،‫ اﻟﺠﺎﻧﺐ اﻟﺼﺤﻴﺢ‬،‫ﺾ اﻟﺼﺤﻴﺢ‬c¬‫ اﻟﻤ‬-Cs 3) ‫ﺾ‬c¬‫ﺔ اﻟﻤ‬cd‫ﺪ ﻫ‬ƒ‫ﺗﺤﺪ‬ .(‫اﻹﺟﺮاء اﻟﺼﺤﻴﺢ‬ • Patient identification (3 Cs- Correct patient, Correct side, Correct procedure). • Patient should be wearing a hospital gown. .‫ﺸﻔﻰ‬Ã‫ﺾ ﺛﻮب اﻟﻤﺴ‬c¬‫ﺠﺐ أن ﻳﺮﺗﺪي اﻟﻤ‬ƒ • Consent form. .‫ﻧﻤﻮذج اﻟﻤﻮاﻓﻘﺔ‬ .‫ﻻ ﺗﻮﺟﺪ ﻗﻴﻮد ﻋﻠﻰ اﻟﻨﻈﺎم اﻟﻐﺬاﺋﻲ‬ • No diet restrictions. .‫ﻞ اﻹﺟﺮاء‬±‫ﺮ اﻟﺴﺎﺑﻖ ذي اﻟﺼﻠﺔ ﻗ‬cd‫اﺟﻤﻊ اﻟﺘﺼ‬ • Collect relevant previous imaging prior to procedure. • Prophylactic dose of broad spectrum antibiotic prior to procedure (immunosupressed patients). ‫ﻞ اﻹﺟﺮاء‬±‫ﻒ ﻗ‬Z‫ﺔ واﺳﻌﺔ اﻟﻄ‬cd‫ﺔ ﻣﻦ اﻟﻤﻀﺎدات اﻟﺤﻴ‬Z‫اﻟﺠﺮﻋﺔ اﻟﻮﻗﺎﺋ‬ .(‫ﻌﺎﻧﻮن ﻣﻦ ﻧﻘﺺ اﻟﻤﻨﺎﻋﺔ‬ƒ ‫)اﻟﻤﺮﺿﻰ اﻟﺬﻳﻦ‬ PROCEDURE: • The patient supine . • A slightly RPO position can help to ensure the CBD is not superimposed over the patient's spine. • A control image of the RUQ should be acquired. • The tip of the T-tube is cleaned with antiseptic. • The T-tube should be raised and tapped to ensure there are no air bubbles in the tube. • A butterfly needle should be inserted into the T-tube. :‫اﻹﺟﺮاء‬ .‫ﺾ‬c¬‫اﻻﺳﺘﻠﻘﺎء اﻟﻤ‬ .‫ﺾ‬c¬‫ع اﻟﺒﻴﻮﻟﻮﺟﻲ ﻓﻮق اﻟﻌﻤﻮد اﻟﻔﻘﺮي ﻟﻠﻤ‬d‫ﺔ اﻟﺘﻨ‬Z‫ﻼ ﻓﻲ ﺿﻤﺎن ﻋﺪم ﻓﺮض اﺗﻔﺎﻗ‬Z‫ ﻗﻠ‬RPO ‫ﺴﺎﻋﺪ وﺿﻊ‬É ‫ﻤﻜﻦ أن‬ƒ .RUQ ‫ﻢ ل‬u‫ﺠﺐ اﻟﺤﺼﻮل ﻋﻠﻰ ﺻﻮرة ﺗﺤ‬ƒ .‫ﻤﻄﻬﺮ‬b T ‫ﻒ ﻃﺮف اﻷﻧﺒﻮب‬Z‫ﻳﺘﻢ ﺗﻨﻈ‬ .‫ﻪ ﻟﻀﻤﺎن ﻋﺪم وﺟﻮد ﻓﻘﺎﻋﺎت ﻫﻮاء ﻓﻲ اﻷﻧﺒﻮب‬Z‫ﻢ ﻋﻠ‬cd‫ واﻟﺘﺼ‬T ‫ﺠﺐ رﻓﻊ اﻷﻧﺒﻮب‬ƒ .T ‫ﺠﺐ إدﺧﺎل إﺑﺮة ﻓﺮاﺷﺔ ﻓﻲ اﻷﻧﺒﻮب‬ƒ • An early filling image should be obtained. • The entire biliary tree should be imaged during injection of contrast medium to the deuodenum. • If the intrahepatic ducts do not fill, the patient can be tilted trendelenburg and further contrast injected. • The patient may need to lie on their left side to fill the left hepatic duct. • At least 2 views of the entire biliary tree should be recorded by spot film, oblique views are often taken. .‫ﻜﺮة‬w‫• \ﺠﺐ اﻟﺤﺼﻮل ﻋﻠﻰ ﺻﻮرة ﺗﻌﺒﺌﺔ ﻣ‬ .‫ﺎﻳﻦ إﻟﻰ اﻻﺛﻨﻲ ﻋﺸﺮ‬w‫ﻤﻠﻬﺎ أﺛﻨﺎء ﺣﻘﻦ وﺳﻂ اﻟﺘ‬¹‫• \ﺠﺐ ﺗﺼ»™ﺮ اﻟﺸﺠﺮة اﻟﺼﻔﺮاو™ﺔ ﺄ‬ .‫ﺎﻳﻦ‬w‫ ﻓ|ﻤﻜﻦ إﻣﺎﻟﺔ اﻟﻤ•™ﺾ إﻟﻰ اﻻﺗﺠﺎە وﺣﻘﻦ اﻟﻤ¼™ﺪ ﻣﻦ اﻟﺘ‬،‫ﺪ‬w¾‫• إذا ﻟﻢ ﺗﻤﺘﻠﺊ اﻟﻘﻨﻮات داﺧﻞ اﻟ‬ .‫ﺪ\ﺔ اﻟ•ﺴﺮى‬w¾‫ﺴﺮ ﻟﻤﻞء اﻟﻘﻨﺎة اﻟ‬Â‫ﻪ اﻷ‬w‫• ﻗﺪ \ﺤﺘﺎج اﻟﻤ•™ﺾ إﻟﻰ اﻻﺳﺘﻠﻘﺎء ﻋﻠﻰ ﺟﺎﻧ‬ .‫ﺎ ﻣﺎ ﻳﺘﻢ اﻟﺘﻘﺎط وﺟﻬﺎت ﻧﻈﺮ ﻣﺎﺋﻠﺔ‬w‫ وﻏﺎﻟ‬،‫ﻤﻠﻬﺎ ﻋﻦ ﻃ•™ﻖ اﻟﻔ|ﻠﻢ اﻟﻤﻮﺿﻌﻲ‬¹‫ﺴﺠ|ﻞ ﻣﻨﻈ•™ﻦ ﻋﻠﻰ اﻷﻗﻞ ﻟﻠﺸﺠﺮة اﻟﺼﻔﺮاو™ﺔ ﺄ‬È ‫• \ﺠﺐ‬ Post Procedure Care • Patient can eat and drink normally. • Warn patient to advise of any itching or rash post procedure. • Patient should remain in hospital for at least 24 hours for observation. • If the T-tube is removed, the wound should be checked for bile leakage for 24 hours. Complications ‫ﻌﺪ اﻹﺟﺮاء‬b ‫ﺔ ﻣﺎ‬ƒ‫رﻋﺎ‬ .‫ﻌﻲ‬Z‫ﻞ ﻃﺒ‬u‫ﺸ‬Ì ‫ﺸﺮب‬Þ‫ﻞ و‬À‫ﺄ‬ƒ ‫ﺾ أن‬c¬‫ﻤﻜﻦ ﻟﻠﻤ‬ƒ .‫ﻌﺪ اﻟﺤﻜﺔ أو اﻟﻄﻔﺢ اﻟﺠﻠﺪي‬b ‫ﺸﺄن أي إﺟﺮاء‬Ì ‫ﻢ اﻟﻤﺸﻮرة‬ƒ‫ﺾ ﻣﻦ ﺗﻘﺪ‬c¬‫ﺗﺤﺬﻳﺮ اﻟﻤ‬ .‫ﺔ‬±‫ ﺳﺎﻋﺔ ﻋﻠﻰ اﻷﻗﻞ ﻟﻠﻤﺮاﻗ‬24 ‫ﺸﻔﻰ ﻟﻤﺪة‬Ã‫ﺾ ﻓﻲ اﻟﻤﺴ‬c¬‫ﻘﻰ اﻟﻤ‬±‫ﺠﺐ أن ﻳ‬ƒ .‫ ﺳﺎﻋﺔ‬24 ‫ﺴﺮب اﻟﺼﻔﺮاء ﻟﻤﺪة‬È ‫ﺤﺜﺎ ﻋﻦ‬b ‫ﺠﺐ ﻓﺤﺺ اﻟﺠ¬ح‬Z‫ ﻓ‬،T ‫إذا ﺗﻤﺖ إزاﻟﺔ اﻷﻧﺒﻮب‬ .‫اﻟﻤﻀﺎﻋﻔﺎت‬ .‫اﻟﻨﺎﺳﻮر اﻟﺼﻔﺮاوي اﻟﻤﺴﺘﻤﺮ‬ • Persistent biliary fistula. .‫اﻟﺘﻬﺎب اﻟﺼﻔﺎق اﻟﺼﻔﺮاوي‬ • Biliary peritonitis. .‫ﺔ‬c‫ﺔ اﻟﺼﻔﺮاو‬Z‫اﻟﺘﻬﺎب اﻷﻗﻨ‬ • Cholangitis.