Procedures exam 1

Cholangiography

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?

1. 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