Biliary system positioning

The largest gland in the body

Liver

The primary function of the liver from an imaging standpoint

Production of bile

The structure that divides the liver into two major lobes

Falciform ligament

The two major lobes of the liver

Right lobe and left lobe

The two minor lobes evident on the visceral surface of the liver

Caudate lobe and quadrate lobe

The vessel supplying oxygenated blood to the liver from the abdominal aorta

Hepatic artery

The vessel carrying blood from the digestive system to be filtered by the liver

Portal vein

The pear shaped organ functioning to store and concentrate bile

Gallbladder

The hormone secreted by the duodenal mucosa that activates muscular contraction and evacuation of the gallbladder

Cholecystokinin (CCK)

The anatomical portion of the gallbladder that is consistent with the cystic duct

Neck of the gallbladder

The anatomical factor responsible for variations in the position of the gallbladder

Body habitus

The two main ducts that join together to form the common hepatic duct

Right and left hepatic ducts

The structure formed by the union of the common hepatic duct and the cystic duct

Common bile duct

The shared passage through which the common bile duct and pancreatic duct empty into the duodenum

Hepatopancreatic ampulla (Ampulla of Vater)

The muscular valve controlling the hepatopancreatic ampulla

Sphincter of the hepatopancreatic ampulla (Sphincter of Oddi)

The alternate term for the main pancreatic duct

Duct of Wirsung

The gland extending from the duodenum to the spleen that functions as both an exocrine and endocrine organ

Pancreas

The four structural regions comprising the pancreas

Head, neck, body, and tail

The medical root term meaning bile

Chole

The medical root term meaning bile duct

Cholangio

The medical root term meaning bile sac or gallbladder

Cholecysto

The medical root term meaning common bile duct

Choledochus

The medical root term meaning liver

Hepato

A condition characterized by the accumulation of bilirubin in the blood

Jaundice

The condition involving dilated, bleeding veins in the esophagus often associated with liver pathology

Esophageal varices

An abnormal accumulation of fluid within the peritoneal cavity

Ascites

The medical term for gallstones

Cholelithiasis

The predominant type of gallstone found in the United States

Cholesterol gallstone

The four primary predisposition factors for developing gallstones

Family history, over age 40, overweight, and female

The imaging modality of choice for diagnosing gallstones

Ultrasound

An imaging exam where contrast is injected into the biliary system during surgery with the C arm angled 20 degrees to move the ducts away from the spine

Operative Cholangiography

The specific patient position for an operative cholangiogram

Supine with the patient's left side elevated 15–20 degrees

The C

arm centering point during an operative cholangiography procedure

The primary projection used for operative cholangiography to move the biliary ducts away from the spine

True PA projection with a 20

The contrast filled structures demonstrated on an operative cholangiogram

Biliary system, a portion of the cystic duct, branches of the hepatic duct, common bile duct, and pancreatic duct

An imaging study performed postoperatively via a drainage tube to demonstrate the caliber and patency of the ducts

Postoperative (T-Tube) Cholangiography

The critical step performed the day before a T-tube cholangiography to prevent air bubbles from mimicking radiolucent stones

Clamping the T-tube so it fills with bile

The preliminary preparation required prior to a postoperative T tube cholangiogram

Preceding meal withheld, cleansing enema 1 hour before (if needed), and a preliminary KUB scout obtained

The patient position utilized for T tube cholangiography after the scout image is taken

Right Posterior Oblique (RPO)

An interventional biliary procedure performed on jaundiced patients when CT or ultrasound shows dilated ducts but the cause remains unclear

Percutaneous Transhepatic Cholangiography (PTC)

An additional therapeutic use for a Percutaneous Transhepatic Cholangiography (PTC)

Placement of a drainage catheter to treat obstructive jaundice

The specific type of "skinny" needle inserted through the skin during a PTC procedure

Chiba needle

The projection type obtained under fluoroscopy once the ductal system is completely filled during a PTC

Spot AP projections

A procedure utilizing a fiber optic endoscope passed through the mouth into the duodenum to cannulate the ampulla and diagnose biliary/pancreatic conditions

Endoscopic Retrograde CholangioPancreatography (ERCP)

The clinical scenarios where an ERCP is highly useful compared to a PTC

When the biliary ducts are not dilated and the ampulla is not obstructed

The initial patient comfort measure taken before passing the fiber

optic endoscope through the mouth during an ERCP

The specific structure that helps create the structural C loop of the duodenum

Head of the pancreas

The anatomical location of the hepatopancreatic sphincter

Junction of the common bile and pancreatic ducts

The most common cause of acute cholecystitis

Cystic duct obstruction by gallstones

The most common cause of acute pancreatitis

Gallstones obstructing bile flow