Biliary tract

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2Dr. Mustafa Zuhair MahmoudB.Sc; SUST {Khartoum, Sudan}M.Sc; AAU {Khartoum, Sudan} & JUREI {Philadelphia, USA}Ph.D, Ludes {Lugano, Swiss} Ph.D, SUST {Khartoum, Sudan}

Sudan University of Science and Technology {SUST}College of Medical Radiological Sciences

BiliaryApparatus(Cholegraphy)

Quick Anatomical Review

The Biliary Apparatus: The bile is drained from the liver by two main ducts, theRight& Left hepatic ducts. The right &Left hepatic ducts leave the liver at the porta hepatic& unites to form the Common Hepatic Duct.

The Common Hepatic Duct -about 3cm in length- joined the cystic duct. (This is the duct from the Gall Bladder) The Cystic Duct& the Common Hepatic Duct together form the Common Bile Duct.

The Common Bile Duct which is about 7.5 cm in length passes behind the 1st part of duodenum& then unites with the pancreatic duct to enter the 2nd part of the duodenum, on the surface of the duodenal papilla. The opening through the duodenum is surrounded by a sphincter muscles, the sphincter of Oddi.

The Gall Bladder: The gall bladder is a pear-shaped sac which lies on the under surface of the liver, to which it is attached by connective tissue. The gall bladder is divided for descriptive purposed into:Fundus.Body.Neck.

Structure of the Gall Bladder: The wall of the gall bladder is composed of three coats: An outer Serous Coat. A middle Fibrous tissue& Smooth muscles coat. An inner Mucous coat.

Biliary Tract& Gall Bladder RadiographySeveral techniques can be used to examine the gall bladder and the biliary tract. In many institution, Sonography is the modality of choice.Terms: Cholegraphy: Is the general term for a radiographic study of the biliary system. Cholecystography: Is the radiographic investigation of the gall bladder. Cholangiography: Is the radiographic study of the biliary ducts. Radiography of both the gall bladder& the biliary ducts is Cholecystangiography or Cholecystocholangiography. Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP) is the procedure to diagnose biliary and pancreatic pathological conditions.

Indications for imaging

- Gallstones, (cholelithiasis).

- Stones of the bile ducts, (choledocholithiasis).

- Cholangitis.

- Cholecystitis.

- Bile duct cancer.

- Infection of the pancreas, liver, or the bile ducts.

Patients Preparation

- On the day before the procedure you will likely be asked not to eat, and to drink only clear liquids.

- Complete fasting in the morning of the examination.

Routes of administration are as follow:

1. By Mouth __ Oral.Contrast Media administration MethodsContrast Media

Biloptin

Route of administration: By Mouth __ Oral.Oral Cholecystogram (OCG)

2. By injection in a vein in a single bolus or by drip infusion __ Intravenous.

Contrast MediaUrographin or Omnipaque

By injection in a vein in a single bolus or by drip infusion __ Intravenous. Route of administration:Intravenous Cholangiogram

3. By direct injection into the ducts:a. Percutaneous Transhepatic Cholangiography (PTC).

Contrast MediaUrographin or Omnipaque

Routes of administration:By direct injection into the ducts.PTC Examination

3. By direct injection into the ducts:b. During biliary tract surgery (operative or immediate), through an indwelling drainagetube, termed a T-Tube (postoperative or delayed).

Contrast MediaUrographin or Omnipaque

Routes of administration:By direct injection into the ducts.Postoperative Cholangiogram, performed with a T-tube

Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP)

is the procedure to diagnose biliary and pancreatic pathological conditions.

Endoscopic Reterograde Cholangio-pancreatogrphy (ERCP) is the procedure to diagnose biliary and pancreatic pathological conditions.

Contrast MediaUrographin or Omnipaque

ERCP

THANKS