Biliary Duct Procedures

Imaging equipment for biliary duct

Fluoroscopy is required during the injection of a contrast medium. Radiographic images may be taken after the fluoroscopic procedure

postoperative cholangiography also termed

T-tube or delayed cholangiography

Follow standard precautions when handling bile

Wear gloves throughout the procedure

Clinical indications: strictures

a region of the biliary ducts may have been narrowed as demonstrated during the operative cholangiogram; this may warrant further investigation

Injection process

because the t-tube catheter has been clamped off, drainage of excess bile is performed at the beginning of the procedure. An emesis basin should be provided for this task.

T-tube or delayed cholangiography is usually performed ...

in the radiology department after a cholecystectomy

patient preparation

preparing the patient for the t-tube cholangiogram varies based on department protocol. The procedure should be clearly explained to the patient and a careful clinical history should be taken. The patient should be placed in a hospital gown and kept NPO (nothing by mouth) for at least 8 hours before the procedure.

The surgeon may be concerned about what in the biliary ducts?

residual stones that went undetected during the surgery

anatomy of biliary ducts

- left hepatic duct -right hepatic duct -common hepatic duct -common bile duct -pancreatic duct (duct of wirsung) -portion of descending duodenum -gallbladder -cystic duct

primary contraindications to t-tube cholangiography include?

hypersensitivity to iodinated contrast media, acute infection of the biliary system, and elevated creatinine or blood urea nitrogen (BUN) levels

Accessory equipment for biliary duct

syringes of various sizes, syringe adaptors, emesis basins, gloves, and sterile drapes are needed

contrast media

t-tube cholangiography can be accomplished through the use of an iodinated, water-soluble contrast media (possibly a diluted concentration to prevent obscuring of small calculi)

what happens after duct drainage and under fluoroscopy control

the iodinated contrast agent is injected fractionally

If it is suspected that residual stones are in the biliary duct what does the surgeon do?

the surgeon places a special T-tube-shaped catheter into the common bile duct during the cholecystectomy. The catheter extends to the outside of the body and is clamped off.

Clinical Indications: Residual Calculi

undetected stones may remain in the biliary ducts after the operative cholangiogram. The t-tube cholangiogram enables the radiologist to determine the location of stones and remove them, if possible, through a specialized catheter