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