Biliary System Pos 2 M4

liver, gallbladder, biliary ducts

Primary function of liver

production of bile

T/F: bile is collected by ducts and carried to the gallbladder for storage or passes into the jejunum

false; passes into the duodenum

2 main hepatic ducts in liver

1. right

2. left

The right and left hepatic ducts join together to form

common hepatic duct

The common hepatic duct units with the cystic duct to form

common bile duct

The common bile duct joins the pancreatic duct to do what?

empty into the duodenum via the hepatopancreatic ampulla (ampulla of Vater)

The ampulla of Vater is controlled by

sphincter of hepatopancreatic ampulla or sphincter of Oddi

Gallbladder and position in body

• thin-walled musculomembranous sac usually found on visceral surface or right lobe of liver

• position varies w/ body habitus

Gallbladder function

• stores & concentrates bile

• evacuates bile when activated by cholecystokinin (hormone)

• neck of gallbladder consistent with cystic duct

Percutaneous Transhepatic Cholangiography (PTC)

• direct injection by Chiba needle (thin) through liver to biliary ducts

• done for jaundice patients

  • ductal system dilated, but cause is unclear

• used to place a drainage catheter to treat obstructive jaundice

Postoperative (T-Tube) Cholangiography

• aka delayed chonlagiography

• contrast injected via T-tube left in common hepatic duct & common bile ducts for postop drainage (after cholecytectomy)

• done to show

  • caliber (diameter) & patency of ducts

  • status of sphincter of ampulla

  • presence of stones

Postop T-Tube Cholangiography procedure

• tube clamped day before

  • fills tube with bile to prevent air bubbles from entering

  • air bubbles mimic radiolucent stones

• preceding meal withheld

• cleansing enema 1 hr before procedure

• preliminary KUB

• patient in RPO with RUQ centered to IR

• contrast injected into t-tube under flouro

• spot/conventional images taken

ERCP

• diagnose biliary & pancreatic pathologies

• method when ducts aren’t dilated & ampulla not obstructed

• fiberoptic endoscope goes thru mouth into duodenum under flouro

• throat sprayed with anesthetic for endoscope passage

• hepatopancreatic ampulla is cannulated (cannula)

• contrast injected into common bile duct

• spot/conventional films taken

Operative (immediate) Cholangiography

• direct injection thru catheter during surgery