Studied by 1 person
Which organ creates bile
liver
What is the function of bile?
emulsifies fats
Excretion and secretion are functions of what?
bile
Excretion
Process by which metabolic wastes are eliminated from the body
Secretion
a process by which substances are produced and discharged from a cell, gland, or organ for a particular function in the organism or for excretion.
What are the parts of the gallbladder?
fundus, body, neck
Biliary tract
the organs and ducts that participate in the secretion, storage, and delivery of bile to the duodenum.
Major function of the gallbladder?
storage, concentration, and evacuation of bile (during digestion)
What hormone activates the contraction of the gallbladder?
Cholecystokinin
When is cholecystokinin released?
when chyme enters the duodenum
Chyme
mixture of enzymes and partially-digested food
Cholecystokinin (CCK)
A hormone secreted by the samll intestine (duodenum) in response to the presence of fats. It promotes release of bile from the gallbladder and pancreatic juice from the pancreas,and reduces stomach motility.
What is the position of the gallbladder for hypersthenic patients?
Hyper-high and away from midline
What sits on the inferior aspect of the liver near right side of the porta Hepatis?
Gallbladder
What is the position of the gallbladder for asthenic patients?
Asthenic- low and near midline
What are the parts of the pancreas?
head, neck, body, tail
What part of the pancreas is located in the curve of the duodenum?
The head
Pancreas
An organs in the abdominal cavity with two roles. The first is an exocrine role: to produce digestive enzymes and bicarbonate, which are delivered to the small intestine via the pancreatic duct. The second is an endocrine role: to secrete insulin and glucagon into the bloodstream to help regulate blood glucose levels.
What is the function of the endocrine portion of the pancreas?
Cells called the islets of Langerhans secrete insulin and glucagon directly into the blood
exocrine pancreas
part of the pancreas that secretes digestive enzymes and bicarbonate into the duodenal lumen
Exocrine glands
Glands that secrete substances outward through a duct
Endocrine gland
Glands of the endocrine system that release hormones into the bloodstream
What does insulin and glucagon do?
maintains blood sugar levels by promoting the glucose absorption of the body
Islets (or Islands) of Langerhans
small specialized collections of cells in the pancreas that manufacture insulin, glucagon, and other hormones
Where does insulin and glucagon secreted from?
Islets of Langerhans
Sphincter of Oddi
controls the amount of bile into the small intestine
What is another name for sphincter of oddi?
hepatopancreatic sphincter
Ampulla of váter
Is formed from the CBD and the main pancreatic duct (duct of wirsung)
Empties through the duodenal papilla, controlled by the sphincter of oddi.
Ampulla of Vater
What is another name from ampulla of vater?
hepatopancreatic ampulla
What happens to the sphincter of Oddi during interdigestive times?
Remains contracted
What happens to the sphincter of Oddi during digestive times?
Relaxes
Choleography
examination of the GB and ducts. It's a general name for all types of choleangiography.
What are two purposes for performing biliary tract examinations?
Patency and condition of ducts
Detection of lesions
Purpose of biliary exams
Who takes the lead in imaging of the biliary tract?
other modalities
How is contrast delivered to the biliary tract?
Direct injection
How many routes of administration of contrast is there for cholegraphy?
4
percutaneous transhepatic cholangiography (PTC)
Procedure in which contrast medium is injected directly into the liver to visualize the bile ducts. Used to detect obstructions such as gallstones in the common bile duct.
Detection of lesions such as calculi or neoplasm; stenosis; lesions of head of pancreas
Purpose of biliary tract examinations
Biliary Calculi
-Cholesterol stones (soft) fatty material that is radiolucent
-Calcium stones (hard) can be seen w/o contrast; radiopauque
Types of Biliary Calculi
What are two type of biliary calculi?
Cholesterol stones and calcium stones
Which type of calcium is more soft and radiolucent?
Cholesterol stones
Types of biliary calculi
Solitary and milk of calcium (sludge)
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatography (ERCP)
cholangi/o
bile duct
ERCP
procedure used to diagnose biliary and pancreatic pathologic conditions
It is useful diagnostic method when the biliary ducts are not dilated and when no obstruction exists at the ampulla
ERCP
What is the purpose for ERCP?
Dx of biliary and pancreatic pathologic conditions, biliary intervention for stone removal, and biliary drainage
Primary indication for ERCP is
removal of biliary calculi
What are other indications for ERCP to be done?
-Cholangitis
-Obstructive jaundice
-Acute biliary pancreatitis
-Eval of pancreatic trauma
-Suspected pancreatic cancer
What are some therapeutic uses for ERCP?
-Sphincterotomy
-Facilitate stone removal
-stenoses treated with balloon dilatation and stent placement
Sphincterotomy
repair stenosis of the sphincter of Oddi
Stenoses
the abnormal narrowing of a passage in the body
When wouldn't you do a ERCP?
Pancreatic pseudocysts
A pancreatic pseudocyst
abnormally expanded area in the pancreas resembling a cyst
How do we detect pseudocysts?
MRI, CT
What is the significance of detecting pseudocysts before an ERCP?
Could rupture the pseudocyst with the scope causing fluid to leak into the peritoneum (can cause death)
Preprocedural care includes
-communication with patient
-Informed consent
-Allergy history
-Informed consent
-Allergy history
-NPO for at least 4 hours
-Start IV with saline
What are atropine and glucagon administered for?
To produce atony of duodenum (decrease peristalsis)
Pontocaine
local anesthetic
What is pontocaine used for?
Used for a gargle for pharyngeal anesthesia
What is the order of procedures for an ERCP?
Atropine and glucagon are administered to produce atony of the duodenum, Pontocaine is used as a gargle for pharyngeal anesthesia, fiberoptic endoscope passed through mouth into duodenum under fluoroscopic control, ampulla of vater located; cannula passed through endoscope, contrast media injected, spot images and radiographs taken.
Antispasmodic drugs
drugs that inhibit hydrochloric acid secretion, smooth muscle contraction, and peristalsis in the gastrointestinal tract to limit muscle spasms
What are the antispasmodic drugs used for an ERCP
atropine or glucagon
What inhibits mobility of GI tract; slows peristalsis?
Glucagon or atropine
Which topical anesthetic is sprayed into the throat or gargled for insertion of the scope?
Pontocaine
Meperidine (Demerol) or fentanyl are used
to treat pain
Diazepam
to treat anxiety
Versed (midazolam) used
to produce sleepiness or drowsiness and relieve anxiety; to produce amnesia (twilight medication)
Team involved in a ERCP
-Nurse
-Anesthetist
-Gastroenterologist
-Radiologist
-Radiographer
-Student
Who performs the ERCP?
gastroenterologist
How is the patient placed on the table for an ERCP?
Patient head to the right in LAO
ERCP key image
Fiberoptic endoscope can be visualized
Cannula
a small tube for insertion into a body cavity, duct, or vessel
How long does it take injected contrast to drain from normal ducts?
Approximately 5 minutes
Why must images be exposed immediately after injection of contrast for an ERCP?
Due to the contrast being drained from normal ducts within 5 minutes.
What kind of contrast medium used for an ERCP?
Water-based iodinated contrast
What kind of water-based iodinated contrast used for an ERCP?
isovue or omnipaque
What is postprocedural care for an ERCP?
-Patient goes to recovery room due to heavy medications
-vitals are monitored
-withheld fluids and food until sensation is returned to throat (pontocaine)
Why must the patient return to a recovery room after a ERCP?
Due to heavy medication given during the procedure
Why must fluids and foods be withheld from the patient after an ERCP?
To avoid possible aspiration due to loss of feeling in their throat due to pontocaine
Aspiration
Breathing fluid, food, vomitus, or an object into the lungs
Possible Complications for ERCP
-medication reactions to contrast or medication
-nausea, vomiting, and sore throat
-perforation of the duodenum, hemorrhage or infection
If there is a blockage at the ampulla what procedures cannot be done?
ERCP (preoperative)
What does PTC stand for?
percutaneous transhepatic cholangiography
Note 
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